Post-primary pulmonary tuberculosis

Last revised by Dr Bashar Karkoush on 30 Jul 2022

Post-primary tuberculosis, also known as reactivation tuberculosis or secondary tuberculosis Is perhaps more correctly designated “tuberculosis in an immunocompetent host” 1. The features are distinctly different to so-called primary tuberculosis which occurs in the absence of immunity.

Pathology

Location

As explained by high oxygen tension and impaired lymphatic drainage, typically there is involvement of:

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

Radiographic features

CT
Parenchymal disease
  • ill-defined patchy consolidation 
  • clustered parenchymal opacification may give rise to a galaxy sign
  • 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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Cases and figures

  • Case 1: pulmonary tuberculosis
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  • Case 2: tuberculous abscess
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  • Case 3
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  • Case 4
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  • Case 5
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  • Case 6
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  • Case 7
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  • Case 8
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  • Case 9
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  • Case 10
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