Primary pulmonary tuberculosis

Last revised by Ciara O'Donnell on 17 Jan 2021

Primary pulmonary tuberculosis is seen in patients not previously exposed to Mycobacterium tuberculosis.

It is most common in infants and children and has the highest prevalence in children under 5 years of age 1.

Primary pulmonary tuberculosis manifests as five main entities:

  • parenchymal disease
    • usually manifests as dense, homogeneous parenchymal consolidation in any lobe
    • however, predominance in the lower and middle lobes (subpleural sites) is suggestive of the disease, especially in adults 1
  • lymphadenopathy
  • miliary opacities
  • clustered parenchymal opacification may give a galaxy sign
  • pleural effusion

In approximately two-thirds of cases, the parenchymal focus resolves without sequelae at conventional radiography; however, this resolution can take up to 2 years. In the remaining cases, a radiologic scar persists that can calcify in up to 15% of cases, an entity that is known as a Ghon focus. Other calcified foci can also be seen, and persistent masslike opacities called tuberculomas are seen in ~10% of cases 1.

Its appearance is often indistinguishable from that of bacterial pneumonia.

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Cases and figures

  • Case 1
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