Tuberculoma is a common condition in developing countries. In some cases, it may mimic a glial lesion, making differential diagnosis challenging. The authors report two cases of giant tuberculoma in young patients age...Tuberculoma is a common condition in developing countries. In some cases, it may mimic a glial lesion, making differential diagnosis challenging. The authors report two cases of giant tuberculoma in young patients aged 14 and 16. A literature review was conducted on these cases. Both patients underwent partial excision. Histology concluded tuberculoma. Anti-tubercular treatment was implemented. The evolution one year later was marked by the persistence of neurological disorders, although they had improved.展开更多
Intraventricular haemorrhage (IVH) is an extremely rare and poorly described complication of central nervous system Tuberculosis (CNS-TB). In this study, we report the case of a 42-year-old man who presented with a we...Intraventricular haemorrhage (IVH) is an extremely rare and poorly described complication of central nervous system Tuberculosis (CNS-TB). In this study, we report the case of a 42-year-old man who presented with a weakness of the left hemibody with diffuse headache, altered consciousness associated with fever. No notion of contagion was noted. Brain computed tomography (CT) showed a hematoma in the occipital horns of the lateral ventricles with peri-lesional oedema of the right hemisphere;after injection of contrast product (CP), there were ring-shaped contrasts in the occipital horn of the lateral ventricle and the right thalamus. Angioscan showed no aneurysms or vascular anomalies. Chest X-ray showed micronodular opacities less than 1.5 cm in size in relation to miliary. Xpert MTB/RIF of sputum and cerebrospinal fluid (CSF) showed Mycobacterium tuberculosis (MT). The patient’s course was favourable under antihypertensive and antitubercular treatment. Conclusion: This case illustrates the diagnostic difficulties of CNS-TB due to the polymorphism of the clinical and radiological presentation of CNS-TB.展开更多
Intracranial tuberculomas are one of the most serious formsof tuberculosis disease after meningitis tuberculosis. It incidence varies around 0.15% - 0.18% in the development world to 5% - 30% of intracranial masses in...Intracranial tuberculomas are one of the most serious formsof tuberculosis disease after meningitis tuberculosis. It incidence varies around 0.15% - 0.18% in the development world to 5% - 30% of intracranial masses in some under developments areas. These tuberculomas, of course ubiquitous, are mostly diagnosed in the adulthood and usually located in the cerebellum and the cerebral hemispheres. Intra ventricular involving is uncommon and just 10 cases had been described in the literature. We report a case of an intraventricular tuberculoma in a 26- year-old man and we discuss the pathogenesis and the radiological findings according this location.展开更多
Backgrounds: Tuberculoma is a granulomatous inflammatory process mimicking a neoplasm, both clinically and radiologically. Although those with an infratentorial origin are rare, this disease is still a diagnostic chal...Backgrounds: Tuberculoma is a granulomatous inflammatory process mimicking a neoplasm, both clinically and radiologically. Although those with an infratentorial origin are rare, this disease is still a diagnostic challenge using conventional workup. However, this disease should not be overlooked because it is essentially curable with proper diagnosis and therapy, usually, a Mycobacterium Tuberculosis (MTB) DNA test is performed. Methods: We retrospectively analyzed the clinical presentations, CSF results, and images of 11 MTB DNA positive and clinically cured cases of infratentorial tuberculoma. Results: Infratentorial tuberculoma usually deteriorated before antituberculosis treatment (ATT). Magnetic resonance imaging showed space-occupying lesions without specific features, 4 within the cerebellum and 7 within the brainstem. Evidence of systemic tuberculosis was found in only 1 case. Clinical manifestations included various combinations of focal signs and symptoms in the brain stem and cerebellum. Cerebrospinal fluid (CSF) findings were also nonspecific. The diagnoses of these cases were based on the positive tests of a nested polymerase chain reaction (N-PCR) assay. Trial therapy with antituberculous drugs resulted in clinical improvement, as documented by MRI in all patients. Conclusions: Infratentorial tuberculoma should be suspected in patients with infratentorial space-occupying lesions who live in geographic areas where tuberculosis is endemic.展开更多
Central nervous system tuberculosis can have protean manifestations.We review the clinical and radiological findings in two cases of cerebral tuberculoma in immuoncompetent patients.These two cases represent the spect...Central nervous system tuberculosis can have protean manifestations.We review the clinical and radiological findings in two cases of cerebral tuberculoma in immuoncompetent patients.These two cases represent the spectrum of variations of clinical and radiological features of cerebral tuberculoma and highlight the controversies in the approach to diagnosis and management.展开更多
Tuberculous infection manifesting as an isolated intramedullary tuberculoma of the spinal cord is distinctly unusual.We report a case of a 35 year old woman presenting with an insidious onset of myelopathy,where MRI s...Tuberculous infection manifesting as an isolated intramedullary tuberculoma of the spinal cord is distinctly unusual.We report a case of a 35 year old woman presenting with an insidious onset of myelopathy,where MRI showed characteristic imaging findings suggestive of intramedullary tuberculosis.展开更多
We report a case of hypodense cerebellar tuberculoma in a 26 year old postpartum lady who presented with one episode of generalized tonic-clonic seizures and discuss the histopathology findings where on CT scan the le...We report a case of hypodense cerebellar tuberculoma in a 26 year old postpartum lady who presented with one episode of generalized tonic-clonic seizures and discuss the histopathology findings where on CT scan the lesion was suspected as low grade glioma.She was started on isoniazid,rifampicin,pyrazinamide,ethambutol and pyridoxine.She is asymptomatic and had no neurological deficits at follow up.展开更多
TUBERCULOSIS （TB） remains one of the leading causes of preventable morbidity and mortality from infectious disease worldwide.1 It is a chronic progressive granulomatous infection caused by Mycobacterium tuberculosis...TUBERCULOSIS （TB） remains one of the leading causes of preventable morbidity and mortality from infectious disease worldwide.1 It is a chronic progressive granulomatous infection caused by Mycobacterium tuberculosis （M. tuberculosis）.展开更多
Background: Neurocysticercosis (NCC) and central nervous system (CNS) tuberculomas often overlap in clinical presentation and imaging. Though the aetio-pathology entirely differs in both the scenarios but there is gre...Background: Neurocysticercosis (NCC) and central nervous system (CNS) tuberculomas often overlap in clinical presentation and imaging. Though the aetio-pathology entirely differs in both the scenarios but there is great confusion in their clinico-radiological evaluation as the findings and appearances are similar in many ways. The stress should be laid out over the salient features of each entity in the background of their presentation. The study was conducted to highlight the differentiation of the clinico-radiological findings in both the entities. Material and Methods: Ten patients between 5 - 15 years (mean age 10.4 years) with complaints of headache and with or without seizures had undergone MRI alone or with CT examinations. Basic sequences of T1W, T2W, T2W FLAIR and T1W contrast studies were carried out in all the cases. CT was carried out in only three cases and contrast was given in two cases. Results: Eight patients were having ring enhancing lesions in post contrast studies in MRI and two had only cystic lesions ranging from 1 - 3 cm in diameter. Conclusion: Seven cases having tuberculomas were confirmed by both the modalities with one case inconclusive. Two cases were diagnosed as neurocysticercosis as per the results. The reasonable achievable target was the goal to differentiate between NCC and tuberculomas in the brain and it was achieved. Contrast MRI and spectroscopy brought out many findings for the distinct features in many cases.展开更多
Pachymeningeal en plaque tuberculoma is a rare manifestation of tuberculosis and has a poor prognosis if not diagnosed early and treated adequately. The aim of the present paper is to collect the reported clinical and...Pachymeningeal en plaque tuberculoma is a rare manifestation of tuberculosis and has a poor prognosis if not diagnosed early and treated adequately. The aim of the present paper is to collect the reported clinical and radiological signs in the literature and compare it with a personal observation to evaluate the possibility of a presumptive diagnosis. A 4-year-old boy presented at the pediatric emergency department with 7 days history of severe headache, vomiting blurred vision and had one partial seizure. His neurologic examination was notable for decreased visual acuity with bilateral papilledema and intact extra-ocular muscles. His neck was rigid. Neuroimaging revealed a multifocal dural-based mass on the fronto-parietal convexity with dense heterogeneous contrast enhancement and hydrocephalus. He has undergone a Ventriculoperitoneal shunt and surgical excision of the mass the next day. Outcome was favorable with antituberculosis therapy and corticosteroids. The clinical presentation and outcome were similar to the reported cases in the literature.展开更多
Background:The clinical manifestations of cardiac masses are diverse and lack specifi city.Here we report a cardiac mass detected by transthoracic echocardiography.Multimodality imaging and pathological fi ndings afte...Background:The clinical manifestations of cardiac masses are diverse and lack specifi city.Here we report a cardiac mass detected by transthoracic echocardiography.Multimodality imaging and pathological fi ndings after the operation confi rmed the mass as mediastinal tuberculoma.Case presentation:A 45-year-old male patient was admitted to our hospital reporting chest tightness,weight loss,and dyspnea for 3 months after exercise.Transthoracic echocardiography showed that there were a large number of pericardial effusions and a soft tissue mass measuring 7.7 cm×4.5 cm in the upper mediastinum,which oppressed the right pulmonary artery and accelerated the blood fl ow of the left pulmonary artery.Contrast-enhanced ultrasonography showed degenerative inhomogeneous high enhancement of and an unclear boundary in the mass.Contrast-enhanced chest CT revealed punctate and patchy calcifi cation in and uneven enhancement of the mass and the lymph nodes around the aortic arch.The mass was diagnosed as a malignant mediastinal tumor.Pathological analysis of the mass revealed chronic granulomatous tuberculosis.The symptoms abated signifi cantly after antituberculosis treatment.The patient remained asymptomatic during follow-up.Conclusion:This report presents a rare case of mediastinal tuberculoma mimicking a malignant cardiac tumor.Multimodality imaging should be incorporated for differentiation of cardiac masses.展开更多
BACKGROUND Intracranial tuberculoma is a rare and serious type of tuberculosis,which mostly occurs in the frontoparietal and cerebellar hemispheres,with predominance in the gray-white matter junction area,while tuberc...BACKGROUND Intracranial tuberculoma is a rare and serious type of tuberculosis,which mostly occurs in the frontoparietal and cerebellar hemispheres,with predominance in the gray-white matter junction area,while tuberculomas only in the cistern are extremely rare with only a few reported cases in the literature.We describe a unique case of isolated tuberculoma in the suprasellar cistern,with only right ocular motility disorder and upper eyelid ptosis.CASE SUMMARY A 5-year-old boy without any medical history presented with right ocular motility disorder and upper eyelid ptosis one month ago.He had no history of fever,headache,vomiting,convulsions,or limb weakness.Neurological examination showed right third cranial nerve palsy with restrictions of eye movements and ptosis,pupil dilation and negative light reflex.Imaging suggested a spaceoccupying lesion in the suprasellar cistern with calcification and ring-enhancement.Moreover,no Mycobacterium tuberculosis was found in cerebrospinal fluid by polymerase chain reaction(PCR).The lesion was initially diagnosed as a tumor,while postoperative pathology combined with PCR indicated tuberculoma.The patient continued postoperative anti-tuberculosis treatment.At present,the patient's condition is stable and the symptoms are partially relieved compared with those before surgery.CONCLUSION This case confirmed that isolated intracranial tuberculoma can occur in the suprasellar cistern.Therefore,for space-occupying lesions in the suprasellar cistern,tuberculoma should be included in the differential diagnosis even if there is no history or indication of tuberculosis infection.展开更多
文摘Tuberculoma is a common condition in developing countries. In some cases, it may mimic a glial lesion, making differential diagnosis challenging. The authors report two cases of giant tuberculoma in young patients aged 14 and 16. A literature review was conducted on these cases. Both patients underwent partial excision. Histology concluded tuberculoma. Anti-tubercular treatment was implemented. The evolution one year later was marked by the persistence of neurological disorders, although they had improved.
文摘Intraventricular haemorrhage (IVH) is an extremely rare and poorly described complication of central nervous system Tuberculosis (CNS-TB). In this study, we report the case of a 42-year-old man who presented with a weakness of the left hemibody with diffuse headache, altered consciousness associated with fever. No notion of contagion was noted. Brain computed tomography (CT) showed a hematoma in the occipital horns of the lateral ventricles with peri-lesional oedema of the right hemisphere;after injection of contrast product (CP), there were ring-shaped contrasts in the occipital horn of the lateral ventricle and the right thalamus. Angioscan showed no aneurysms or vascular anomalies. Chest X-ray showed micronodular opacities less than 1.5 cm in size in relation to miliary. Xpert MTB/RIF of sputum and cerebrospinal fluid (CSF) showed Mycobacterium tuberculosis (MT). The patient’s course was favourable under antihypertensive and antitubercular treatment. Conclusion: This case illustrates the diagnostic difficulties of CNS-TB due to the polymorphism of the clinical and radiological presentation of CNS-TB.
文摘Intracranial tuberculomas are one of the most serious formsof tuberculosis disease after meningitis tuberculosis. It incidence varies around 0.15% - 0.18% in the development world to 5% - 30% of intracranial masses in some under developments areas. These tuberculomas, of course ubiquitous, are mostly diagnosed in the adulthood and usually located in the cerebellum and the cerebral hemispheres. Intra ventricular involving is uncommon and just 10 cases had been described in the literature. We report a case of an intraventricular tuberculoma in a 26- year-old man and we discuss the pathogenesis and the radiological findings according this location.
文摘Backgrounds: Tuberculoma is a granulomatous inflammatory process mimicking a neoplasm, both clinically and radiologically. Although those with an infratentorial origin are rare, this disease is still a diagnostic challenge using conventional workup. However, this disease should not be overlooked because it is essentially curable with proper diagnosis and therapy, usually, a Mycobacterium Tuberculosis (MTB) DNA test is performed. Methods: We retrospectively analyzed the clinical presentations, CSF results, and images of 11 MTB DNA positive and clinically cured cases of infratentorial tuberculoma. Results: Infratentorial tuberculoma usually deteriorated before antituberculosis treatment (ATT). Magnetic resonance imaging showed space-occupying lesions without specific features, 4 within the cerebellum and 7 within the brainstem. Evidence of systemic tuberculosis was found in only 1 case. Clinical manifestations included various combinations of focal signs and symptoms in the brain stem and cerebellum. Cerebrospinal fluid (CSF) findings were also nonspecific. The diagnoses of these cases were based on the positive tests of a nested polymerase chain reaction (N-PCR) assay. Trial therapy with antituberculous drugs resulted in clinical improvement, as documented by MRI in all patients. Conclusions: Infratentorial tuberculoma should be suspected in patients with infratentorial space-occupying lesions who live in geographic areas where tuberculosis is endemic.
文摘Central nervous system tuberculosis can have protean manifestations.We review the clinical and radiological findings in two cases of cerebral tuberculoma in immuoncompetent patients.These two cases represent the spectrum of variations of clinical and radiological features of cerebral tuberculoma and highlight the controversies in the approach to diagnosis and management.
文摘Tuberculous infection manifesting as an isolated intramedullary tuberculoma of the spinal cord is distinctly unusual.We report a case of a 35 year old woman presenting with an insidious onset of myelopathy,where MRI showed characteristic imaging findings suggestive of intramedullary tuberculosis.
文摘We report a case of hypodense cerebellar tuberculoma in a 26 year old postpartum lady who presented with one episode of generalized tonic-clonic seizures and discuss the histopathology findings where on CT scan the lesion was suspected as low grade glioma.She was started on isoniazid,rifampicin,pyrazinamide,ethambutol and pyridoxine.She is asymptomatic and had no neurological deficits at follow up.
文摘TUBERCULOSIS （TB） remains one of the leading causes of preventable morbidity and mortality from infectious disease worldwide.1 It is a chronic progressive granulomatous infection caused by Mycobacterium tuberculosis （M. tuberculosis）.
文摘Background: Neurocysticercosis (NCC) and central nervous system (CNS) tuberculomas often overlap in clinical presentation and imaging. Though the aetio-pathology entirely differs in both the scenarios but there is great confusion in their clinico-radiological evaluation as the findings and appearances are similar in many ways. The stress should be laid out over the salient features of each entity in the background of their presentation. The study was conducted to highlight the differentiation of the clinico-radiological findings in both the entities. Material and Methods: Ten patients between 5 - 15 years (mean age 10.4 years) with complaints of headache and with or without seizures had undergone MRI alone or with CT examinations. Basic sequences of T1W, T2W, T2W FLAIR and T1W contrast studies were carried out in all the cases. CT was carried out in only three cases and contrast was given in two cases. Results: Eight patients were having ring enhancing lesions in post contrast studies in MRI and two had only cystic lesions ranging from 1 - 3 cm in diameter. Conclusion: Seven cases having tuberculomas were confirmed by both the modalities with one case inconclusive. Two cases were diagnosed as neurocysticercosis as per the results. The reasonable achievable target was the goal to differentiate between NCC and tuberculomas in the brain and it was achieved. Contrast MRI and spectroscopy brought out many findings for the distinct features in many cases.
文摘Pachymeningeal en plaque tuberculoma is a rare manifestation of tuberculosis and has a poor prognosis if not diagnosed early and treated adequately. The aim of the present paper is to collect the reported clinical and radiological signs in the literature and compare it with a personal observation to evaluate the possibility of a presumptive diagnosis. A 4-year-old boy presented at the pediatric emergency department with 7 days history of severe headache, vomiting blurred vision and had one partial seizure. His neurologic examination was notable for decreased visual acuity with bilateral papilledema and intact extra-ocular muscles. His neck was rigid. Neuroimaging revealed a multifocal dural-based mass on the fronto-parietal convexity with dense heterogeneous contrast enhancement and hydrocephalus. He has undergone a Ventriculoperitoneal shunt and surgical excision of the mass the next day. Outcome was favorable with antituberculosis therapy and corticosteroids. The clinical presentation and outcome were similar to the reported cases in the literature.
文摘Background:The clinical manifestations of cardiac masses are diverse and lack specifi city.Here we report a cardiac mass detected by transthoracic echocardiography.Multimodality imaging and pathological fi ndings after the operation confi rmed the mass as mediastinal tuberculoma.Case presentation:A 45-year-old male patient was admitted to our hospital reporting chest tightness,weight loss,and dyspnea for 3 months after exercise.Transthoracic echocardiography showed that there were a large number of pericardial effusions and a soft tissue mass measuring 7.7 cm×4.5 cm in the upper mediastinum,which oppressed the right pulmonary artery and accelerated the blood fl ow of the left pulmonary artery.Contrast-enhanced ultrasonography showed degenerative inhomogeneous high enhancement of and an unclear boundary in the mass.Contrast-enhanced chest CT revealed punctate and patchy calcifi cation in and uneven enhancement of the mass and the lymph nodes around the aortic arch.The mass was diagnosed as a malignant mediastinal tumor.Pathological analysis of the mass revealed chronic granulomatous tuberculosis.The symptoms abated signifi cantly after antituberculosis treatment.The patient remained asymptomatic during follow-up.Conclusion:This report presents a rare case of mediastinal tuberculoma mimicking a malignant cardiac tumor.Multimodality imaging should be incorporated for differentiation of cardiac masses.
文摘BACKGROUND Intracranial tuberculoma is a rare and serious type of tuberculosis,which mostly occurs in the frontoparietal and cerebellar hemispheres,with predominance in the gray-white matter junction area,while tuberculomas only in the cistern are extremely rare with only a few reported cases in the literature.We describe a unique case of isolated tuberculoma in the suprasellar cistern,with only right ocular motility disorder and upper eyelid ptosis.CASE SUMMARY A 5-year-old boy without any medical history presented with right ocular motility disorder and upper eyelid ptosis one month ago.He had no history of fever,headache,vomiting,convulsions,or limb weakness.Neurological examination showed right third cranial nerve palsy with restrictions of eye movements and ptosis,pupil dilation and negative light reflex.Imaging suggested a spaceoccupying lesion in the suprasellar cistern with calcification and ring-enhancement.Moreover,no Mycobacterium tuberculosis was found in cerebrospinal fluid by polymerase chain reaction(PCR).The lesion was initially diagnosed as a tumor,while postoperative pathology combined with PCR indicated tuberculoma.The patient continued postoperative anti-tuberculosis treatment.At present,the patient's condition is stable and the symptoms are partially relieved compared with those before surgery.CONCLUSION This case confirmed that isolated intracranial tuberculoma can occur in the suprasellar cistern.Therefore,for space-occupying lesions in the suprasellar cistern,tuberculoma should be included in the differential diagnosis even if there is no history or indication of tuberculosis infection.
文摘目的总结胸膜结核瘤(pleural tuberculoma,PTM)的临床特征,分析发病高危因素。方法回顾性分析2017年4月至2021年4月在南京市第二医院收治的56例PTM患者(病例组)资料,首先总结该56例患者的临床特征,其次与60例结核性胸膜炎(tuberculous pleurisy,TPE)(对照组)未合并PTM的病例对比,分析罹患PTM的高危因素。结果PTM的平均年龄为(29.04±6.95)岁,男女性别无差异。从诊断TPE起,PTM的平均发病时间为(4.29±2.34)个月。42例(75%)PTM位于下肺叶。病例组和对照组临床症状、基础疾病差异无显著性,在合并影像学比较中,病例组胸膜增厚更常见(44.64%vs 23.33%,P=0.02),同时胸水ADA(adenosine deaminase)水平高于对照组[(48.32±19.19)U/L vs(44.79±24.57)U/L,P=0.03]。在细胞免疫功能检测中,CD_(4)^(+)、CD_(8)^(+)T淋巴细胞绝对计数和CD_(4)^(+)/CD_(8)^(+)T比值2组差异无显著性(P>0.05),而病例组CD_(4)^(+)和CD_(8)^(+)T细胞的活化标志物Ki-67+的表达明显高于对照组(36.64±16.50 vs 7.19±5.23,P<0.001;33.31±15.94 vs 5.02±7.13,P<0.001)。结论PTM的发病年龄较轻,多见于TPE治疗半年内出现。罹患PTM的高危因素较复杂,胸膜增厚、ADA水平升高以及T淋巴细胞的免疫活化失调可能是PTM发病的高危因素。
