Abstract：
Tuberculosis (TB) is an airborne infectious disease caused by Mycobacterium tuberculosis (MTB). Although it typically affects the lungs (pulmonary TB), one-fifth of TB cases present as extrapulmonary TB. The diagnosis of extrapulmonary TB is often overlooked due to its atypical clinical and radiological manifestations. Differentiating TB from neoplastic conditions poses significant challenges. A 33-year-old female patient was admitted to the emergency clinic with shortness of breath, cough, and abdominal pain. Postero-anterior chest X-ray revealed massive pleural effusion leading to mediastinal shift. With a preliminary diagnosis of malignant pleural effusion, a pleural catheter was inserted, and the patient was referred for a positron emission tomography (PET/CT) to assess the primary site and the optimal location for a biopsy. The PET/CT revealed asymmetric soft tissue thickening on the left side of the nasopharynx, and increased fluorodeoxyglucose (FDG) uptake in the left cervical lymph nodes raised suspicion regarding primary nasopharyngeal cancer. Additionally, there was an increased FDG uptake observed in the mass lesion located in the right upper lobe, mediastinal lymph nodes, pleural surfaces in the left hemithorax, perihepatic areas, and peritoneum, indicating diffuse metastatic disease. Tuberculosis diagnosis was confirmed through biopsies demonstrating granulomatous inflammation in the lung and nasopharynx, along with culturing MTB from pleural effusion. Positron emission tomography played a crucial role in identifying sites of TB involvement. Despite its rarity, healthcare professionals should consider nasopharyngeal TB as a potential diagnosis when evaluating nasopharyngeal masses.
摘要：
结核病（TB）是由结核分枝杆菌（MTB）引起的空气传播传染病。虽然它通常会影响肺部（肺结核），1/5的结核病例表现为肺外结核。肺外结核的诊断由于其不典型的临床和放射学表现而常常被忽视。将TB与肿瘤病症区分开提出了重大挑战。一名三十三岁女病人因呼吸急促入院急诊,咳嗽,和腹痛。后前胸部X线检查显示大量胸腔积液导致纵隔移位。随着恶性胸腔积液的初步诊断，插入胸膜导管，患者接受正电子发射断层扫描(PET/CT)检查,以评估原发部位和活检的最佳位置.PET/CT提示鼻咽左侧不对称软组织增厚，左颈部淋巴结中氟代脱氧葡萄糖(FDG)摄取的增加引起了对原发性鼻咽癌的怀疑。此外,在位于右上叶的肿块病变中观察到FDG摄取增加，纵隔淋巴结，左半胸的胸膜表面，肝周区域，还有腹膜,表明弥漫性转移性疾病。结核病诊断通过活检证实肺和鼻咽肉芽肿性炎症，同时从胸腔积液中培养MTB。正电子发射断层扫描在确定结核病参与部位中起着至关重要的作用。尽管它很罕见,在评估鼻咽肿块时,医护人员应考虑将鼻咽结核作为潜在诊断.
