among various microbial pathogens , mycobacterium tuberculosis ( tb ) infection has been regarded as an important subject of scientific studies on the diseases prevalent among pre - modern peoples . by evidences of anatomical pathology , researchers could report the presence of tb in the archaeologically obtained human samples . using the ancient samples , the phylogeny of tb continues to have been traced by the molecular biological techniques ( 1234 ) . although more historical knowledge on tb infection has been obtained by studies on archaeological samples worldwide , there were very few reports on the presence of tb cases from ancient human remains in korea . considering that tb was known to have been endemic in this country until quite recent days , the deficiency of medical evidences on the tb infection in archaeological samples of korea looks exceptional . in this regard , the current case about calcified pulmonary nodules ( pn ) that were recently identified in 350-yr - old - korean mummy is very meaningful to concerned researchers . by differential diagnosis based upon ct radiological findings , we can conclude that this looks the first - ever case of pulmonary tb identified among archaeologically obtained , pre - modern korean samples . a female mummy was discovered in april 2010 , from a joseon tomb discovered in mungyeong county of korea ( fig . after the mummy was moved to our laboratory , the sex determination was made as a female , by its external genitalia and by morphology of the pelvic bone ( 5 ) . the mummy 's age was estimated to be 40 - 44 yr old , by the degeneration pattern of the auricular and pubic symphyseal surfaces of the hipbones ( 6 ) . ( 1992 ) ( 7 ) on right maxillary first premolar as about 47.2 yr - old . next , the ct scan was performed on this case with a 64 mdct scanner ( vct , ge healthcare , milwaukee , wi , usa ) at seoul national university hospital , korea . using the helical technique ( 120 kvp ) , a spiral volume from head to toe all of the data were reconstructed into axial images representing 1.25 mm thicknesses at 1.25 mm intervals . these images were transferred to a workstation ( advantage windows workstation 4.3 ; ge healthcare ) preparatory to post - processing , by which coronal and sagittal multi - planar reformation and volume - rendering images were obtained . volume - rendering images were obtained by invesalius 3.0.0 beta 5 ( cti , campinas , brazil ) . the ct images exhibited six radiopaque nodules in right - sided lung within thoracic cavity , at the level of thoracic vertebrae ( tv ) 1 to 6 ( fig . 2 ) . briefly , at tv1 level , a radiopaque nodule ( # 1 ) was located in front of trachea , especially at the right side of it ( fig . a small - sized nodule ( # 2 ) was also identified at tv3 , along the trachea . another radiopaque nodule ( # 3 ) was found in the mummified lung ( tv4 level ) that was displaced to posterior thoracic cavity ( fig . 2b ) . at tv5 level , two large nodules ( # 4 and # 5 ) the nodule # 6 was found in the right lung , around costovertebral junction at tv6 level ( fig . 2e . from tv1 to tv7 level , we found presumptive pleural adhesions on ct , mainly in the right - sided thoracic cavity . for post - factum validation of the ct findings , we dissected the mummy in the department of anatomy , seoul national university college of medicine ( korea ) . we made an incision along the lower borders of the xiphoid process and the 12th ribs . from the lower tip of the xiphoid process the skin was then turned back to expose the internal organs within the abdominal cavity . the thoracic cavity was opened , specifically by cutting the costal cartilages of the ribs , and then by incising the costal or sternal origins of the diaphragmatic muscles . the sternum was then bent back to reveal the organs within the chest cavity . during the dissection , we found possible sign of pleural adhesion in her right - sided thorax , which is well correspondent to the findings on ct images ( fig . 3 ) . the calcified pns identified on the ct images were counter - checked by our dissection findings . briefly , the calcified pns were located in the apical segment of upper lobe , superior and posterior basal segments of lower lobe in the right lung . next , we cut the nodules ( # 4 and # 5 ) to examine their nature . the deposition of calcium seen in the center of nodules re - confirmed the radiopacities on ct images as dystrophic calcification ( fig . our results clearly show multiple calcified parenchymal nodules in the hilar region of the mummy 's right lung . most calcified pn on radiological images are clinically benign though some malignant diseases ( e.g. primary or metastatic lung cancer ) , even if the chances are rare , also cause it . based on the radiological pattern of calcified pn , we think that the current case might have been old healed granulomatous disease ( calcified ghon complex ) . though intra - thoracic , diffuse nodular calcifications include granulomatous tissue response caused by various pathogens ( histoplasma capsulatum etc . ) ( 8) , pulmonary tb might be the first candidate in this case because it is one of the most common etiologies for calcified pn detected in the patients ( 9 ) . however , we should note that many other diseases such as infections , pulmonary metastases , pulmonary hamartoma , chronic hemorrhage , pneumoconiosis , carcinoid , amyloids , and other idiopathic disorders etc . differential diagnosis between them is therefore very important for the confirmation of our radiological diagnosis of the current case as pulmonary tb . first of all , we do not regard this case as primary lung cancer because calcification in lung cancer is very rare ; and if any , they show punctuate , amorphous and reticular patterns . we also rule out lung carcinoid because it is generally a central pulmonary tumor associated with dense amorphous calcification . if the current pns were neoplasms , pulmonary metastases might be a better candidate for this case . however , as we could not get any radiological evidences for calcifications caused by primary cancer in the organs other than lung , calcified pns in this study are not likely to be caused by pulmonary metastases . as for pulmonary hamartoma ( ph ) , we note that it appears as sharply outlined , solitary pn . ph generally associates popcorn - shaped round / oval pn with a central nidus and a laminated calcification pattern . the focal collection of fat that alternates with foci of calcification in pn is also a specific characteristic of ph on ct ( 9 ) . considering that the current case did not show such radiological patterns , we can rule out it easily from the diagnosis of current case . as amyloids generally show well - defined 2 - 4 mm nodules with abnormal reticular opacities , diffusely dispersing in lung parenchyme ( 11 ) , it can be excluded from the current diagnosis . it is well known that calcified pn is also made by infectious diseases ( e.g. healed disseminated histoplasmosis or miliary tuberculosis ) , hemosiderosis , pneumoconiosis , talcosis etc . however , we can rule out them without difficulties because they are very rare diseases , exhibiting the radiological patterns of multiple high - density , diffuse small calcification nodules throughout the lung parenchyma ( 910 ) . taken together , the general pattern observed in the current korean mummy case was well matched with previous clinical findings reported from modern patients ( 1213 ) . as far as our ct radiography and dissection results are concerned , the current case is likely to be the healed case of pulmonary tuberculosis ( calcified ghon complex ) , the first case identified among archaeologically obtained , pre - modern korean ( joseon ) samples . in fact , revealing the earlier history of tb infection was a serious quest in paleopathology . bartels ( 14 ) reported the evidence of spinal tuberculosis in a neolithic skeleton discovered near heidelberg , germany in 1907 . spinal destructions possibly caused by pott 's disease were also identified in the ancient human bones from two different italy sites , dated between 3500 and 4000 bc ( 1516 ) . more recent studies on ancient tuberculosis cases were successfully summarized by roberts and manchester ( 17 ) in 2007 and ortner ( 18 ) in 2003 . although many pathological studies on archaeologically obtained human or animal samples worldwide have already been focused upon the evidences of ancient tuberculosis remained in them ( 19 ) , similar researches were very rarely performed on the counterpart samples discovered in korea . only an exception was the ancient skeletal samples discovered in nukdo archaeological site ( gyeongsangnam - do ) , which was dated to the first century bc . upon the ancient korean skeletons , suzuki et al . ( 20 ) reported presumptive osteological sign of spinal tuberculosis having occurred in ancient korean people . in fact , in the case , tv12 was collapsed wedge - shaped , and being fused with tv11 . though this might be the first - ever report discussing about the presumptive tuberculosis case identified among ancient korean remains , we should admit the technical limitation of this because the conclusion of suzuki et al . in fact , clear evidences on the tb infection affecting the lung parenchyme of ancient peoples therefore were not available yet in this country . in this regard , the current case is very significant to concerned researchers in korea . as calcified pn in our report can be identified as an evident sign of pulmonary tb in a joseon mummy , we show that the disease could have been also prevalent in pre - modern korean society . considering recent studies on ancient mycobacteria dna worldwide have provided valuable addition to the knowledge of molecular evolution of the infectious disease , tb infecting human samples should be accumulated more in the future even from archaeological samples of korea as well .