This is a 53-years old man, alcoholic, with fever and weight loss.
The CT scan showed a focal lesion with spiculated margins in the right apex anteriorly. Posteriorly there were satellite bronchocentric nodules, highly suggestive of tuberculosis. It wasn’t clear though whether these were old or active. Sputum was negative for acid-fast bacilli (AFB). Because of the “mass-like” appearance of the focal lesion, it was decided to go ahead with a CT guided biopsy rather than bronchoscopy. The biopsy was simple and straightforward with a 20G coaxial biopsy gun. The final diagnosis was tuberculosis on histology and culture.
Tuberculosis simulating malignancy and vice-versa is a constant problem in patients above the age of 35. It is necessary in all instances to get microbiological or histological proof of diagnosis before starting treatment.
Rules: All masses in the lungs in Indian patients are not necessarily malignancy. All mass-like lesions need to be biopsied.