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- W2894588320 abstract "SESSION TITLE: Lung Cancer SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Lung cancer is the most common cancer worldwide and was the cause of 1.69 million deaths in 2015. In tuberculosis prevalent areas of the world, lung cancer is often overlooked and erroneously diagnosed as tuberculosis. Pulmonary tuberculosis treatment in these areas is commonly administered based on risk factors, clinical symptoms and radiographic findings alone. Confirmatory testing for active pulmonary tuberculosis is imperative to prevent a delay in diagnosis and treatment of lung cancer. CASE PRESENTATION: 77-year-old female with PMH of asthma and heart failure who recently immigrated from Senegal presents for evaluation for 1-year history of cough. Patient never smoked and had no occupational exposures. Her cough had progressively worsened with expectoration of copious amounts of white sputum for the past few weeks prior to admission. She reported coughing, exertional dyspnea, watery diarrhea, and weight loss of 20 pounds in 6 months; denied fever, chills, night sweats or hemoptysis. Vital signs were stable and she was afebrile. Clinical examination revealed a chronically ill-appearing thin African woman with no signs of distress, saturating 94% on RA. Lung examination showed decreased breath sounds on the left side and coarse crackles in posterior R upper lung zone. Initial labs were unremarkable. CXR demonstrated right-sided patchy airspace opacities and near-complete opacification of the left hemi thorax. Subsequent CT chest revealed extensive loss of volume on the left side with pleural thickening and LUL cavitation. There were consolidative changes in the R lung with extensive tree-in-bud opacities, cavitating nodules and significant subcarinal LAD. Given patient’s radiographic findings, symptoms and recent immigration status from Senegal there was significant suspicion of pulmonary tuberculosis. She was treated with antibiotics for bacterial pneumonia and placed on respiratory isolation for sputum induction. QuantiFERON was negative. Bronchoscopy with BAL was performed. There were no endobronchial lesions, bronchial mucosa appeared normal but with significant bronchorrhea. Smears for AFB were negative. Cytology was consistent with adenocarcinoma of the lung. DISCUSSION: Mucin producing adenocarcinoma can often mimic pulmonary infections both radiographically and clinically, especially in nonsmokers. In parts of the world where TB is prevalent, this type of lung cancer can easily be confused with TB on clinical and radiographic grounds. Microbiological analysis is needed to rule out active tuberculous lung disease. In cases were microbiological analysis is unrevealing, further work up including biopsy is necessary to exclude an alternative diagnosis such as lung cancer. CONCLUSIONS: Clinicians must maintain a high index of suspicion of lung cancer and cannot rely on radiographic imaging alone to differentiate between malignant and infectious lung disease. Reference #1: Bhatt M, Kant S, Bhaskar R. Pulmonary tuberculosis as differential diagnosis of lung cancer. South Asian Journal of Cancer. 2012;1:36-42. Reference #2: Hammen I. Tuberculosis mimicking lung cancer. Respiratory Medicine Case Reports. 2015;16:45-47. DISCLOSURES: No relevant relationships by Louis Gerolemou, source=Web Response No relevant relationships by Ameer Rasheed, source=Web Response No relevant relationships by Madeeha Shahzadi, source=Web Response" @default.
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- W2894588320 date "2018-10-01" @default.
- W2894588320 modified "2023-09-25" @default.
- W2894588320 title "TB OR NOT TB" @default.
- W2894588320 doi "https://doi.org/10.1016/j.chest.2018.08.546" @default.
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