A Case of Difficult to Diagnose Intrathoracic Mass

Lung masses are often frequently linked to neoplasm, but they can pose diagnostic challenges due to their varied etiologies, especially in tuberculosis (TB)-endemic regions like India, where infectious causes must not be overlooked.Here, we present a case of a 70-year-old ex-smoker male with symptoms susceptive of lung malignancy, including hemoptysis, chronic cough, shortness of breath, and chest pain.His hematological investigations were within normal limits, and imaging studies showed a solitary space-occupying lesion in the right-upper lobe.Multiple diagnostic attempts, including computed tomography-guided fine-needle aspiration cytology (FNAC) and bronchoscopy, were inconclusive.The patient was discharged upon request and advised for regular follow-up.However, upon follow-up visit, symptoms were not improved, and the patient was re-admitted for further work-up.This time, Mycobacterium tuberculosis was finally identified in bronchoalveolar lavage fluid and repeat FNAC material.Notably, the patient exhibited isoniazid monoresistant tuberculosis.The diagnosis of tuberculoma was confirmed, emphasizing the importance of considering TB when evaluating a lung mass, especially in high-prevalence areas.Collaboration between specialties and comprehensive microbiological testing proved pivotal in reaching an accurate diagnosis and initiating appropriate treatment.This case underscores the complexity of diagnosing TB when it mimics malignancy, necessitating a thorough diagnostic approach, continued monitoring, and follow-up for optimal patient management.