CHEST Guidelines-Pulmonary-Artery-Invasion-Caused-by--em-Mycobacter

Pulmonary-Artery-Invasion-Caused-by--em-Mycobacter

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This article presents a rare case of pulmonary artery invasion caused by Mycobacterium tuberculosis in a 62-year-old immunocompetent woman. The patient was initially misdiagnosed with pneumonia and bronchitis before imaging revealed a mediastinal mass with pulmonary artery invasion, raising suspicions of lung cancer due to its malignant-like characteristics. Further diagnostic work, including endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), identified noncaseating granulomas but no cancer cells, indicative of a granulomatous disease. Pathological analysis of pleural biopsies later confirmed the presence of Mycobacterium tuberculosis complex. Despite the rarity of pulmonary artery invasion by tuberculosis—commonly associated with malignancies or certain fungal infections—the patient's case highlights the need for thorough microbial testing in differential diagnosis.<br /><br />The discussion section notes the unusual manifestation of tuberculosis in this case, which typically does not involve large vascular structures. Tuberculosis usually affects the pulmonary and extrapulmonary systems without vascular invasion, which is instead often linked to malignancies. The case underscores the challenging nature of diagnosing extrapulmonary tuberculosis, emphasizing the importance of considering it as a differential diagnosis when encountering mass-like images suggesting malignancy.<br /><br />Given the case's complexity, a multi-disciplinary approach involving pulmonary, thoracic surgery, and infectious disease specialists was utilized. The patient opted against surgery due to high operative risks and continues on a medical treatment regimen, reporting sustained improvement. Conclusively, the case stresses the crucial role of tissue cultures and microbiological testing to avoid misdiagnosis, given that Mycobacterium tuberculosis can mimic malignancy.<br /><br />Authors declare no financial conflicts and acknowledge contributions from Cleveland Clinic departments. The article was published by the American College of Chest Physicians in 2016.

Keywords

pulmonary artery invasion

Mycobacterium tuberculosis

immunocompetent

misdiagnosis

mediastinal mass

granulomatous disease

EBUS-TBNA

differential diagnosis

extrapulmonary tuberculosis

microbiological testing