Abstract Background Pseudotumoral pulmonary tuberculosis (TB) is an atypical presentation that mimics lung malignancy, occurring in 3.5-4.5% of immunocompetent individuals even in endemic regions. We present three cases confirmed by histopathology using radial endobronchial ultrasound-guided (r-EBUS) transbronchial lung biopsy, highlighting its diagnostic utility in sputum-negative patients with peripheral lung lesions. Case Reports Case 1: Female in her 20’s, presented with an incidental finding of pulmonary mass on her pre-employment chest x-ray. Her sputum TB Genexpert was negative and CT scan showed an irregularly shaped right upper lobe mass with spiculated borders, pleural attachment, and satellite nodules. Bronchoscopy with r-EBUS and biopsy revealed granulomatous inflammation with langhans-type giant cells and caseation necrosis. She responded well with standard PTB regimen. Case 2: Male in his 20’s, no prior comorbidities, presented with an incidental finding of pulmonary mass on his pre-employment chest x-ray. His sputum TB Genexpert was negative and his CT scan revealed an enhancing mass with spiculated border in the medial segment of the right middle lobe. Bronchoscopy with r-EBUS and biopsy was performed which showed chronic granulomatous inflammation with langhans-type giant cells. He was then treated with standard anti-Koch medication. Case 3: Female in her 40’s, with a previous history of breast fibroadenoma, presented with increasing abdominal girth and had an incidental finding of heterogeneously enhancing mass on the superior lingula of the left lung. She was advised for bronchoscopy with r-EBUS and colonoscopy where findings revealed chronic inflammation with caseating granuloma and multinucleated giant cells. She was then managed as disseminated TB with standard TB regimen. Conclusion Pseudotumoral tuberculosis is a rare presentation that obscures diagnosis in immunocompetent adults. This series underscores the importance of considering TB even among sputum-negative adults with lung masses in TB-endemic countries. The study highlights the advent of utilizing r-EBUS for the timely and accurate diagnosis of Pseudotumoral TB in patients with peripheral lung lesions. This abstract is funded by: None
Quizon et al. (Fri,) studied this question.