Progressive primary tuberculosis

Case contributed by Dr Abidin Kilincer


Lack of appetite, loss of weight and cough without sputum.

Patient Data

Age: 14 years
Gender: Female

Chest radiograph shows some upper zone opacities and diffuse millimetric nodules.

CT scan demonstrates numerous milimetric nodules. Also note patchy consolidations in bilateral posterior segments of the upper lobes. Mediastinal window shows subcarinal  lymphadenopathy.


After initiation of triple antimycobacterial drug treatment (4 weeks later from first x-ray), the degree of opacity has improved. 

Case Discussion

Clinical and radiologic features of tuberculosis vary depending on which organ system is affected. Furthermore, it can mimic many other diseases (1,2).

Pulmonary tuberculosis is classically divided into primary and postprimary (reactivation) tuberculosis. Primary tuberculosis is most common in infants and children, so it has been considered a disease of childhood. Radiologic manifestations of primery tuberculosis are parenchymal disease, lymphadenopathy, miliary disease, atelectasis and pleural effusion (1, 2). However, chest radiograph may be normal in 15% of cases (3).

Progressive primary tuberculosis is observed in 5-10% of patients with primary tuberculosis. It is most commonly seen in children younger than 1 year of age, teenagers and in black people. The radiological features of progressive primary tuberculosis are similar to postprimary tuberculosis. İn both entities, findings of parenchymal disease are patchy consolidation (particularly in the apical and posterior segments of the upper lobes) and cavitation (2, 4). In addition to this, miliary disease is also seen in progressive primary tuberculosis.

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Case information

rID: 44389
Case created: 19th Apr 2016
Last edited: 24th Jul 2017
System: Chest
Inclusion in quiz mode: Included

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