Table of Contents

HK J Paediatr (New Series)
Vol 25. No. 2, 2020

HK J Paediatr (New Series) 2020;25:115-118

Case Report

Papillary Thyroid Carcinoma Mimicking Miliary Tuberculosis in a 14-year-old Boy

ES Song, YY Lee, HJ Baek, E Lee


A 14-year-old boy was referred to our hospital because of the incidental finding of numerous nodular lesions in both lungs. He had been hospitalised at a local orthopaedic department for pin removal after fixation for ankle fracture. On chest radiography for regular check-up prior to the operation, multiple nodular lesions were observed. Physical examination revealed normal results. Chest computed tomography (CT) confirmed numerous tiny nodular lesions in both lungs. Mycobacterium tuberculosis was not detected in either the sputum or bronchoalveolar lavage samples. Neck CT showed a 1.1 cm ill-defined nodular lesion with calcification in the right thyroid gland. Fine needle aspiration of the thyroid gland and multiple metastatic neck lymph nodes was performed and the histopathologic finding yielded a diagnosis of metastatic papillary thyroid cancer. He was scheduled to undergo total thyroidectomy in combination with radioactive iodine treatment. If miliary infiltrates are found on chest radiography, metastatic tumours including papillary thyroid cancer as a differential disease mimicking miliary tuberculosis should be considered to avoid misdiagnosis and delayed diagnosis.

一名14歲男孩因偶然發現雙肺有許多結節性病變而轉介到本院。他因踝關節骨折而入住當地醫院,進行骨科治療,其後需取出固定針。術前常規胸片檢查發現多發結節性病變。體檢結果正常。胸部電腦斷層掃描 (CT)證實兩肺許多微小的結節病變。痰液和支氣管肺泡灌洗液均未檢出結核分枝桿菌。頸部CT發現右側甲狀腺有一個1.1 cm的模糊結節狀病變伴有鈣化。經甲狀腺細針穿刺及頸部多處轉移淋巴結之組織病理檢查,診斷為轉移性甲狀腺乳頭狀癌。他計劃接受甲狀腺全切除加放射性碘治療。如果在胸片上發現粟粒性浸潤,應考慮包括甲狀腺乳頭狀癌在內的轉移性腫瘤,作為粟粒性肺結核的鑒別診斷,以避免誤診和延誤診斷。

Keyword : Children; Miliary tuberculosis; Papillary thyroid carcinoma



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