Introduction: Tuberculosis (TB) is a global health problem with alarming rate of morbidity and mortality. With its multitude presentation, it is considered a diagnostic chameleon as it may resemble several clinical conditions including malignancy, given similarities between the two conditions in terms of clinical and imaging features.

Case Report: Here we present an illustrating case of an 83-year-old nonsmoker male who presented with intractable cough of two months duration. The blood parameters and sputum reports were not contributory to a specific diagnosis. His computed tomography (CT) imaging findings suggested a heterogeneously enhancing mass in right lower lobe and favored a diagnosis of lung cancer. So, for confirmation he underwent a transcutaneous CT guided lung biopsy for the mass but interestingly on histopathological evaluation, it turned out to be tuberculosis.

Discussion: Tuberculosis is a communicable and preventable disease. Pulmonary TB (PTB) can mask or imitate lung cancer imaging features. A battery of tests is available to differentiate between the two, however, microbiological and histopathological results are the gold standard. An accurate diagnosis is must to initiate appropriate treatment and to avoid toxic chemotherapy and unnecessary surgery.

Conclusion: Pulmonary tuberculosis (PTB) can have an atypical radiological presentation where it counterfeits lung cancer imaging. The case highlights that a diagnosis of PTB should always be considered in a TB endemic country like India.

Keywords: Pulmonary tuberculosis, Lung cancer, Contrast enhanced computed tomography.

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Dr Shruti Thakur

Assistant Professor, Department of Radiodiagnosis, IGMC, Shimla, Zip code 171001