Pulmonary tuberculosis presenting as a hilar mass

Tuberculosis (TB) is a great mimicker due to its various unusual and atypical presentations. Mass-like lesions in thoracic radiology may raise the suspicion of lung malignancy. A man in his early 50s complained of cough, low-grade fever and dyspnoea. Chest radiograph was suggestive of a right hilar mass. Contrast-enhanced CT of the thorax revealed right perihilar consolidation and mediastinal lymphadenopathy. The lesion was encasing the major vessels, causing luminal narrowing. Flexible bronchoscopy showed multiple mucosal nodules in the right lobar bronchi. Histopathology of the endobronchial biopsy showed chronic inflammatory cell infiltrate, while endobronchial ultrasound-guided fine needle aspiration cytology from mediastinal lymph nodes showed numerous caseating epithelioid cell granulomas. Cartridge-based nucleic acid amplification test of lymph node aspirate detected Mycobacterium tuberculosis that was not resistant to rifampicin. So, the final diagnosis was pulmonary TB. The man improved with 6 months of standard antituberculosis therapy. This case represents an uncommon radiological presentation of pulmonary TB.