Presentation
Six-month history of cough with occasional hemoptysis.
Patient Data
At least 2 cavities in the 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. An airway communicates with one of the right upper lobe cavities. 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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