CTICasesRapidly Progressing Disseminated Adenocarcinoma Mimicking Tuberculosis
Imaging findings
Initial CT shows a cavitary nodule with surrounding consolidation and necrotic-looking mediastinal lymphadenopathy. Over three months, despite antituberculosis treatment, the lesion worsened, progressing to a massive area of consolidation, necrosis, and septal thickening in the lung, with extensive necrotic lymphadenopathy throughout the abdomen and pelvis. Biopsies from multiple sites (lung, nodes, retroperitoneum) confirmed adenocarcinoma, with all tuberculosis tests being negative.
Key takeaways
Rapidly progressing cavitary lung lesions with necrotic lymphadenopathy, even in a patient with a history of tuberculosis, should not solely be attributed to infection. Malignancy, particularly aggressive adenocarcinoma, can present with a similar fulminant course and widespread dissemination, emphasizing the need for biopsy for definitive diagnosis, especially when empirical treatment fails.
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