Post-primary tuberculosis

Case contributed by Ali Abougazia


Hemoptysis for several months.

Patient Data

Age: 30 years
Gender: Male

CT Chest


The left upper lung lobe, mainly the apico-posterior segment, shows marked fibrotic changes with septal thickening, peripheral honeycombing, tractional bronchiectasis and subpleural bulla as well as small anterior segment of left upper lung lobe atelectasis. Decreased left upper lung lobe volume is noted with resultant left-ward shift of the upper mediastinum and trachea and upward shift of the left hemidiaphragm.

Bilateral scattered areas of tree-in-bud pattern are as well seen in both lung lobes, most prominently at the superior segment of right lower lung lobe.

Multiple prevascular, para-tracheal and sub-carinal heavily calcified lymph nodes are seen.

The upper sections of the abdomen show porta hepatis, celiac and mesenteric calcified lymph nodes.

Annotated image

Close up images showing the bronchiectasis and tree-in-bud pattern.

Case Discussion

The described findings are those of post-primary TB with left upper lung lobe fibrosis, endobronchial spread of infection and mediastinal, mesenteric TB lymphadenitis.

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