Primary pulmonary tuberculosis: Ranke complex
Patient presented to the E.D. with severe breathlessness and productive cough. She had a history of persistent moderate asthma and chronic ischemic heart disease
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Descended hemidiaphragms bilaterally. Calcified fibrogranuloma located in the axillary region of the right lung field (Ghon lesion). Multiple high intensity round-oval masses, in the hilar region bilaterally (suggestive for calcified lymph nodes). Pleuroseptal fibrosis in the axillary region of the right lung field.
This patient had no history of tuberculosis infection. A primary infection is often asymptomatic, and it is discovered years later incidentally on x-ray done for other reasons (as in this case). The infection can be confirmed by a tuberculin skin test (also called Mantouex test).
In most cases primary TB infection is localized, forming a caseating granuloma (tuberculoma), which eventually calcifies forming the Ghon lesion.
In some cases hilar lymphadenopathy is present which also heals with calcification. When both are present the combination is called Ranke complex.