Imaging features and management of tuberculomas: a review of cases and literature.

Aims: To describe the imaging features of patients presenting with soft tissue masses and a provisional diagnosis of soft tissue tumours, for whom biopsy confirmed the presence of necrotising granulomata consistent with tuberculoma.

Material and methods: A review of the histopathology database for patients who had a diagnosis of necrotising granulomata in nonspinal sites. Patients with bone and joint-based pathology were excluded. Patient age, sex, lesion location, and relevant history were recorded, as were the radiographic, magnetic resonance imaging (MRI), and US findings.

Results: Four males and three females were included, with a mean age of 45.7 years (range 20-71 years). Radiographs showed soft tissue calcification in two cases. On MRI, three lesions were mildly hyperintense on T1W TSE images, and a 'penumbra sign' was seen in six cases. T2W FSE and fat suppressed PDW FSE/STIR sequences demonstrated mixed fluid/solid signal intensity in all cases. All patients showed peri-lesional oedema, while postcontrast studies in two patients showed rim enhancement and heterogeneous enhancement, respectively. On US, one lesion appeared mainly solid, and six were predominantly fluid. US-guided needle biopsy established the diagnosis of necrotising granulomatous infection in all cases.

Conclusion: Soft tissue tuberculomas can present as soft tissue masses mimicking sarcomas. However, the presence of a 'penumbra sign' on T1W TSE sequences and peri-lesional oedema should raise the possibility of infection. Biopsy specimens should therefore be sent for both histopathology and microbiology culture and sensitivity.