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Tuberculosis with endobronchial spread

Case contributed by Stefan Tigges
Diagnosis certain

Presentation

Six-month history of cough with occasional hemoptysis.

Patient Data

Age: 35 years
Gender: Male

At least 2 cavities right lung surrounded by multiple small pulmonary nodules. Left lung clear, normal cardiomediastinal silhouette, no pleural effusion.

Multiple cavities in the posterior segment of the right upper lobe as well as a cavity in the superior segment of the right lower lobe. Innumerable surrounding "tree in bud nodules". Minimal left lower lobe nodules, no lymphadenopathy, no pleural effusion.

Case Discussion

This patient had sputum-positive mycobacterium tuberculosis. Development of cavities "allows" the infection to spread endobronchially, manifesting as "tree in bud" nodules. In contrast, hematogenous spread of tuberculosis to the lungs results in miliary tuberculosis which has a random nodule pattern, with a relatively uniform distribution of ~2 mm nodules, many of which touch pleural and fissural surfaces. 

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