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Thymic tuberculosis preoperatively evaluated with thallium-201 SPECT: two resected cases.

Takashi Iwata¹, Kiyotoshi Inoue, Shinjiro Mizuguchi

¹Department of Thoracic Surgery, Osaka City University Hospital, Osaka, Japan.

Annals of Thoracic and Cardiovascular Surgery : Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia

|March 30, 2007

Summary

Thymic tuberculosis can mimic invasive thymoma on imaging. Thallium-201 SPECT can help diagnose thymic tuberculosis in immunocompromised patients with anterior mediastinal masses.

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Area of Science:

Infectious Diseases
Radiology
Thoracic Surgery

Background:

Anterior mediastinal masses are often diagnosed as thymoma.
Thymic tuberculosis is rare and can be misdiagnosed.
Immunocompromised status increases the risk of opportunistic infections like tuberculosis.

Observation:

Two patients with anterior mediastinal tumors, initially suspected as thymoma, underwent thallium-201 SPECT.
Planar scintigraphy showed no abnormalities, but SPECT revealed thallium uptake in the mediastinal mass.
Both patients had underlying conditions predisposing to infection (rheumatoid arthritis with steroid therapy, diabetes mellitus).

Findings:

Post-operative diagnosis revealed caseous granuloma in the thymus, confirming thymic tuberculosis.
Thallium-201 SPECT, particularly when planar imaging is negative, can aid in diagnosing thymic tuberculosis.
Surgical resection was curative for both patients.

Implications:

Consider thymic tuberculosis in immunocompromised patients with anterior mediastinal masses showing SPECT-positive thallium uptake.
Thallium-201 SPECT may improve diagnostic accuracy for unusual thymic pathologies.
Early diagnosis and treatment of thymic tuberculosis can lead to favorable outcomes.