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Anterior Mediastinal Mass: A Rare Presentation of Tuberculosis

DOI: 10.1155/2011/635385

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We report a case of a 14-year-boy who presented to us with a low-grade fever with evening rise for 9 months. Along with this, the patient also reported a reduction in his appetite and body weight. He had a mild dry cough but no respiratory symptoms otherwise. There was no other localization for fever on history. He received antitubercular therapy, based on abnormal chest radiograph. However, there was no relief in his symptoms. General physical examination revealed mild fever. Systemic examination was unremarkable. Blood investigations done for fever were noncontributory. Computed tomographic (CT) scan of the chest revealed a mediastinal mass compressing the trachea. The possibilities of lymphoma or germ cell tumour were considered. A biopsy from the mass under CT guidance was performed. The histopathology revealed multiple epithelioid cell granulomas with necrosis, and the diagnosis of tuberculosis was made. The clinical course of this patient and the relevant literature is presented in this paper. 1. Introduction The anterior mediastinal space is almost a virtual space. However, the multiplicity of the structures it contains and the diversity of disease processes affecting them make it a region of great clinical interest. This cavity encloses muscle, ligaments, fat tissue, and parenchymatous organs such as thymus, thyroid, and ectopic parathyroid gland. Mediastinal masses are commonly encountered in clinical practice. However, they represent a challenging and urgent diagnostic problem because the differential diagnoses range from absolutely benign to highly malignant conditions, and delay in diagnosis may be fatal. The common anterior masses include thymoma, lymphoma, and germ cell tumours [1, 2]. An isolated mediastinal mass without lung parenchymal lesion is an uncommon presentation of tuberculosis [3, 4]. Here, we present a case of anterior mediastinal mass compressing the trachea which was histopathologically diagnosed as tubercular and treated successfully with antituberculosis therapy (ATT). 2. Case Summary A 14-year-old boy presented to us in July 2009 with low-grade, evening rise fever since March 2008. He also complained of reduction in appetite and weight loss of 8?kg during this period. He had a mild dry cough. However, there was no history of shortness of breath, chest pain, hemoptysis, hoarseness of voice, or dysphagia. There was no other significant history to localize the cause of fever. He received antituberculosis therapy (ATT) for these symptoms and abnormal chest radiograph. He was treated for the first time for 4 months from March

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