Discrete pleural nodules associated with a parasternal mass: an unusual manifestation of tuberculosis

The case presented describes an unusual appearance of thoracic tuberculosis with multiple pleural nodules associated with a parasternal mass as depicted on computed tomography. The patient is a 22-year-old woman who presented with pleuritic chest pain, a left parasternal mass, and weight loss. The pleura of the left hemithorax was studded with multiple low-attenuation, rim-enhancing nodules, and a left parasternal mass with similar imaging features was seen anterior to an enlarged left internal mammary lymph node. There were no pulmonary parenchymal changes nor any mediastinal or hilar lymphadenopathy. Cytologic examination of the specimen obtained with fine needle aspiration of the pleural and parasternal masses yielded granulomatous inflammation. The symptoms remitted with antituberculous chemotherapy and a follow-up CT obtained 6 months later showed complete resolution of the pleural nodules and parasternal mass and considerable regression of the left internal mammary lymph node. Involvement of the pleura with discrete nodules in the absence of parenchymal changes or mediastinal lymphadenopathy is rare in tuberculosis. To the best of the present authors' knowledge, the combination of a tuberculous parasternal mass and multiple pleural nodules as the sole manifestations of thoracic tuberculosis has not been reported previously.