[A case of symmetrical and bilateral tuberculoma of both lung apices]

A 28-year-old man with solitary nodular shadows in both lungs was admitted. The erythrocyte sedimentation rate was accelerated, with elevation of the serum IAP values, and the tuberculin reaction was strongly positive. The X-Ray film of the chest revealed symmetrical and bilateral nodular shadow in both lung apices. Both nodular lesions revealed a tendency to grow, pleural indentation and spiculated margins. Moreover, the tomogram film showed convergence of the pulmonary vein branch in the central part of the left apex nodule. Since it was extremely difficult to distinguish these lesions from malignant nodules based on just radiographic findings, an exploratory thoracotomy was carried out. The histologic diagnosis of both nodules was tuberculoma. Currently, the radiologic criteria used to distinguish between benign and malignant lesions are assessment of size, contour, absence or presence of tumor growing tendency by serial radiographs, calcification as well as the relation between the lesion with the pulmonary vasculature. It was concluded that, as was shown by this case, the radiographic criteria appear to be insufficient to categorize the nature of a lesion into benign or malignant. Consequently, more reliable non-invasive techniques would be desirable for the accurate diagnosis of tuberculosis.