European Journal of Radiology 44 (2002) 33–36 Case report Bilateral multiple pulmonary tuberculous nodules mimicking metastatic disease Macit O. Arıyu¨ rek a , Musturay Karc¸aaltıncaba a, *, Figen B. Demirkazık a , Hadi Akay d , Gokhan Gedikoglu c , Salih Emri b a Department of Radiology, Hacettepe Uniersity School of Medicine, Sihhiye, 06100 Ankara, Turkey b Department of Chest Diseases, Hacettepe Uniersity School of Medicine, Sihhiye, 06100 Ankara, Turkey c Department of Pathology, Hacettepe Uniersity School of Medicine, Sihhiye, 06100 Ankara, Turkey d Department of Thoracic Surgery, Ankara Uniersity School of Medicine, Sihhiye, 06100 Ankara, Turkey Received 14 November 2000; received in revised form 24 July 2001; accepted 25 July 2001 Abstract We present CT findings of a young woman who has bilateral pulmonary nodules mimicking metastases. Clinical presentation with active multiple pulmonary macronodules without cavitation responsive to treatment is an atypical manifestation of pulmonary tuberculosis. We reviewed the causes of multiple pulmonary nodules, role of radiological findings in differential diagnosis and parenchymal manifestations of pulmonary tuberculosis in this report. © 2002 Elsevier Science Ireland Ltd. All rights reserved. www.elsevier.com/locate/ejrad 1. Introduction Tuberculosis is a world wide health problem both in developed and underdeveloped countries. Typical radi- ologic findings of primary and postprimary tuberculosis are well described and also some atypical findings have been reported [1 – 3]. To our knowledge presentation of pulmonary tuberculosis as multiple pulmonary nodules responsive to antituberculosis therapy has not been reported. We report CT findings of a young woman before and after antituberculosis therapy, presenting with multiple pulmonary nodules measuring 10 – 25 mm in diameter without cavitation. 2. Case report A 26-year-old woman was admitted to hospital be- cause of right sided pleuritic chest pain. Her complaints had started 3 days ago. She had malaise and mild anorexia. There was no history of past medical illness. She was a non-smoker, single and a nurse at a community hospital. There was no history of fever, chills, night sweats, weight loss, purulent sputum, tuberculosis, or recent travel. On physical examination the patient was a thin woman who appeared sick. No cutaneous lesions or lymphadenopathy was found. The rest of the examina- tion was normal. The urine was normal. The hematologic tests and blood chemistry values were normal. Her ppd test was positive, however, she had been vaccinated with for BCG three times. Sputum induction was performed. Acid resistant bacilli and PCR for tuberculosis were negative in induced sputum. Radiographs of the chest revealed multiple bilateral nodules at the periphery of the lungs. Spiral CT examination of the chest revealed 11 peripherally located nodules with a diameter range between 1 and 2.5 cm (Fig. 1). Two of the nodules were located at the superior lingular segment of the left lobe * Corresponding author. Present address: Department of Radiol- ogy, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, 9200 W Wisconsin Avenue, Milwaukee, WI 53226, USA. Tel.: +1-414-805-2173; fax: +1-414-259-9290. E-mail address: mkarcaal@hacettepe.edu.tr (M. Karc¸aaltıncaba). 0720-048X/02/$ - see front matter © 2002 Elsevier Science Ireland Ltd. All rights reserved. PII:S0720-048X(01)00402-8