Pulmonary tuberculosis

Case contributed by Sarah AlJahdali

Presentation

Fever and cough with hyperglycemia for 10 days. On antibiotics for 8 days

Patient Data

Age: 20 years
Gender: Male
X-ray

There is heterogeneous consolidation and acinar opacification with cavitation in both mid lung zones compatible with bronchopneumonia, active TB needs to be excluded. There is contiguous hilar opacification. 

CT

Multifocal confluent tree-in-bud nodules with associated extensive consolidations, most of them demonstrating central lucencies in keeping with cavitation. The largest cavitation is seen in the superior right lower lobe, measuring approximately 73 x 52 mm.

No pleural effusion or no pneumothorax.

Enlarged bilateral hilar lymph nodes, the largest one on the right, measuring 21 x 14 mm. Subcentimeter right paratracheal, prevascular and subcarinal lymph nodes. 
 

Case Discussion

The described findings in this case were highly suggestive of an infectious process such as active/post primary TB, which was later confirmed on sputum culture.

In such cases, it is important to promptly notify the referring physician as well as the technologist performing the scan, especially if the patient was not on isolation precautions.

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