Presentation
Chronic cough, fever and weight loss
Patient Data
Left hemithorax shows a large cavitating lesion in the upper zone with widespread patchy linear and nodular opacities.
Cavitating lesion with air-fluid level, in the left upper lobe with widespread patchy linear and nodular opacities (tree in bud appearance) along with consolidation.
Features suggestive of post-primary pulmonary tuberculosis with endobronchial spread.
Case Discussion
Post-primary pulmonary tuberculosis, also known as reactivation TB or secondary TB 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
- superior segments of the lower lobes
Typical appearance of post primary TB is that of patchy consolidation or poorly defined linear and nodular opacities.
Post-primary infections are far more likely to cavitate than primary infections, and are seen in 20-45% of cases. In the vast majority of cases they develop in the posterior segments of the upper lobes (85%). The development of an air-fluid level implies communication with the airway, and thus the possibility of contagion. Endobronchial spread along nearby airways is a relatively common finding, resulting in a relatively well-defined 2-4 mm nodules or branching lesions tree-in-bud appearance on CT.
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