Pulmonary tuberculosis

Case contributed by Melbourne Uni Radiology Masters


Sudanese, 10kg weight loss, several bouts of haemoptysis and ongoing fevers.

Patient Data

Age: 24-year-old
Gender: Male

Chest radiograph

The lungs are clear, there is no pulmonary nodule or infiltrate identified, the pleural spaces are normal. There is mediastinal widening and large hilar lymph nodes bilaterally.

The heart size and shape is within normal limits.

Conclusion: There are changes of extensive mediastinal and hilar lymphadenopathy identified. CT scan of the thorax is indicated.


CT Chest

Multiple enlarged mediastinal and hilar lymph nodes are seen forming large conglomerate masses. The larger nodal components measure 30 x 37 x60 mm within the right paratracheal region and 36 x25 x50 mm within the subcarinal region. There also enlarged axillary lymph nodes measuring up to 1 cm in short axis.

Numerous nodules are also demonstrated in the lungs bilaterally measuring up to 5 mm in size. Some nodules are of perilymphatic distribution with evidence of fissural nodularity. There is no cavitation. No zonal predominance. No pleural or pericardial effusion.

Although this contrast phase is too early for the splenic parenchyma assessment, there are some hypodense splenic nodules. The remainder of the upper abdominal viscera appears within normal limits. No suspicious osseous lesions.

Conclusion: Extensive lymphadenopathy is seen in the presence of numerous pulmonary nodules of perilymphatic distribution most consistent TB or lymphoma. Splenic lesions should be further assessed with a dedicated CT Abdomen/Pelvis 

Case Discussion

Transbronchial biopsy was diagnostic for TB

This case illustrates extensive mediastinal lymphadenopathy with central low attenuation. 

The partially imaged splenic hypodense nodules are nonspecific for this contrast phase, both tuberculosis or lymphoma could give lesions similar to that. 

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Case information

rID: 38167
Published: 19th Nov 2015
Last edited: 14th Aug 2019
System: Chest
Tag: rmh
Inclusion in quiz mode: Included

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