Post-primary pulmonary tuberculosis

Post-primary tuberculosis, also known as reactivation tuberculosis or secondary tuberculosis usually occurs during the first and second years time following the initial infection later. Reactivation frequently in the setting of a decreased immune status and usually involves the lung apex. 

Pathology

Location
  • apical and posterior segments of the upper lobe
  • superior segment of lower lobe 

Radiographic features

CT
Parenchymal disease
  • ill-defined patchy consolidation 
  • cavitation usually develops within the consolidation
  • fibroproliferative disease with coarse reticulonodular densities
  • endobronchial spread with "tree-in-bud" appearance, best appreciated on HRCT
  • healing results in fibrosis, volume loss and traction bronchiectasis
  • lymphadenopathy occurs only in 5% cases
Airway disease

Central airway involvement results in bronchial stenosis which may lead to lobar collapse associated with traction bronchiectasis and mucoid impaction. 

Pleural disease
  • occurs in a minority of cases (18%)
  • small pleural effusion
  • pleural thickening
  • pleural calcification
Chest wall involvement

Chest wall involvement occurring due to direct extension from pulmonary disease manifests as bone and/or cartilage destruction and cutaneous fistula formation.


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Article Information

rID: 17867
System: Chest
Section: Pathology
Synonyms or Alternate Spellings:
  • Reactivation tuberculosis
  • Reactivation TB
  • Post-primary TB

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