2025 Volume 67 Issue 10 Pages 1556-1561
A 69-year-old man was referred to the Department of Respiratory Medicine at our hospital after abnormal shadows were detected in his left lung during a medical check-up. Contrast-enhanced CT revealed a 76×34 mm mass in the left upper lobe, located cephalic to the aortic arch, adjacent to the esophagus, along with clustered enlargement of mediastinal lymph nodes. Biopsy was necessary to differentiate between pulmonary tuberculosis and malignancy. Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was initially considered, the anatomical location was challenging. Therefore, the patient was referred to the gastroenterology deparfent for transesophageal EUS-FNA. The EUS was hypoechoic with clear borders and irregular margins. We performed FNA and found that the smear was positive for Ziehl-Neelsen staining and identified Mycobacterium tuberculosis based on nucleic acid amplification test positivity. The final diagnosis was pulmonary tuberculosis with associated tuberculous lymphadenitis.
