Presentation
Cough, low-grade fever, weight loss and night sweats.
Patient Data
Large cavitating lesion with an air-fluid level in the right upper zone with surrounding patchy consolidation.
Large partially septated cavitating lesion with an air-fluid level in the posterior segment of the right upper lobe with surrounding patchy consolidation as well as poorly defined linear and nodular opacities "tree-in-bud appearance" extending to the anterior segment of the right upper lobe and apical segment of the lower lobe. No hilar or mediastinal lymphadenopathy.
Case Discussion
The clinical presentation and the radiographic and CT features are most consistent with post-primary pulmonary tuberculosis with endobronchial spread.
Post-primary pulmonary tuberculosis, also known as reactivation tuberculosis or secondary tuberculosis occurs years later, frequently in the setting of a decreased immune status. In the majority of cases, post-primary TB within the lungs develops in either posterior segments of the upper lobes or superior segments of the lower lobes.
The development of an air-fluid level implies communication with the airway, and thus the possibility of contagion.
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