case_images: PMC10630663_01
case_images: Chest X-ray (CXR) of a 33-year-old male from the Gambia with previous history of tuberculosis who presented with epigastric pain, weight loss and fatigue. The CXR shows consolidation in the upper zone of the right lung (white arrow).
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case_images: PMC10630663_01_gr1.jpg
case_images: fig1
case_images: While the ultrasound showed no abnormality, the CXR revealed consolidation in the upper zone of the right lung and was described as suspicious for pulmonary TB by the local radiologist (Fig. 1).
case_images: Computed tomography (CT) and 18F-FDG-PET/CT scans of a 33-year-old male from the Gambia with previous history of tuberculosis who presented with epigastric pain, weight loss and fatigue. The CT scan revealed a consolidation in the right upper lobe consistent with post-tuberculosis lung disease such as fibrotic bands (left image, coronal CT scan). The PET/CT shows FDG-avid hot lesions (SUVmax 9.06 SUVbw) in the right upper lobe (top middle picture) and a smaller consolidation in the middle lobe (SUVmax 2.69 SUVbw, bottom middle picture). Total lung glycolysis (TLG) is a semiautomated technique to calculate the total lung glycolytic activity above a threshold (background lung avidity above SUVmax = 1, right picture). Highlighted regions of interest (ROIs) are circulated in pink and light blue. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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case_images: PMC10630663_01_gr2.jpg
case_images: fig2
case_images: A CT chest demonstrated a dense nodular consolidation in the apex of the right lung and a small cavitary lesion with discrete tree-in-bud and ground glass opacification surrounding the cavity (Fig. 2). The PET/CT demonstrated high FDG uptake (SUVmax 9.06 SUVbw, total lung glycolysis (TLG) of 151.62 SUVbw*ml) with a total lesion volume above SUV = 1 of 63.0 ml of the apical lesion of the right lung, suggesting a highly inflamed and active process as opposed to cold lesions that have been described as scarred tissue of previous TB (Fig. 2). The decision was taken to perform a CT-guided biopsy of the lesion with the highest FDG uptake: despite demonstrating granulomatous tissue Xpert MTB/RIF Ultra and smear microscopy of the tissue sample remained negative.