Newly Appearing Tuberculous Pulmonary Masses during Antituberculous Treatment of Tuberculous Pleurisy: Radiographic and CT Findings

PURPOSE: To evaluate the imaging findings of tuberculous pulmonary masses developing during antituberculous treatment of tuberculous pleurisy. MATERIALS AND METHODS: The serial chest radiographs of 134 patients with tuberculous pleurisy were retrospectively assessed by two observers who recorded the presence of pulmonary masses observed on follow-up radiographs with their imaging findings. Four patients underwent chest CT scans. RESULTS: On chest radiographs, 29 masses were observed in 14 patients (10.4%) comprising seven men and seven women aged 21-52(mean, 33) years. The interval between the onset of pleurisy and the development of masses varied between 1 and 7 months. The lesions were single in nine patients and multiple in five; all developed in the hemithorax affected by pleurisy and 21 were located subpleurally. The CT scans obtained in four patients, demonstrated 14 masses in the peripheral lung. The location of ten of these was subpleural; eight of the ten showed extrapleural extension, and associated satellite nodules and ground-glass opacity were observed in six. Contrast-enhanced CT scans showed that enhancement pattern was peripheral in five, heterogeneous in five and homogeneous in four. Follow-up radiography indicated that all masses had become smaller. CONCLUSION: Tuberculous pulmonary masses may develop during antituberculous treatment of tuberculous pleurisy as single or multiple masses. Characteristically, a peripheral or subpleural pulmonary location is noted, and the CT findings include heterogeneous or peripheral rim enhancement, extrapleural extension and associated ground-glass opacity or satellite nodules.