Primary pulmonary tuberculosis - Ranke complex

Case contributed by Hunor Sukosd


Patient presented to the ED with severe breathlessness and productive cough. She had a history of persistent moderate asthma and chronic ischemic heart disease

Patient Data

Age: 85 years
Gender: Female

Descended hemidiaphragms bilaterally. Calcified fibrogranuloma located in the axillary region of the right lung field (Ghon lesion). Multiple high-density round/oval masses, in the hilar region bilaterally (suggestive for calcified lymph nodes). Pleuroseptal fibrosis in the axillary region of the right lung field.

Case Discussion

This patient had no history of tuberculosis infection. 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 Mantoux 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.

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