Presentation
Bronchiectasis and left lung cavitary lesions following treatment of pulmonary TB with recurrent episodes of hemoptysis and chronic left chest pain.
Patient Data
Massive left lung bullae, bronchiectasis and scarring with retraction of the trachea, anterior junction line and mediastinum to the left.
Compensatory hyperinflation of the right lung with herniation to the left.
Rib crowding of the left upper hemithorax.
The trachea is deviated to the left.
Left lung bronchiectasis and complete cavitary destruction of the left lung parenchyma with scarring, volume loss and rib crowding.
Compensatory hyperinflation of the right lung with herniation across the midline.
Scattered centrilobular emphysema of the right lung.
Mild mosaic attenuation of the right lung.
Fine centrilobular micronodules of the right lung posterior segment.
Case Discussion
Pulmonary tuberculosis (lung) is caused by Mycobacterium tuberculosis. It is divided into primary and post-primary types, with the latter usually occurring in adults.
Clinical findings are dependent on the manifestation of infection but classically include cough, loss of weight, fatigue, and drenching night sweats 1. The most common presentation of post-primary TB is parenchymal consolidation with thick-walled cavitation. Consolidation may begin with a patchy pattern but if not treated may progress to lobar pneumonia 2. Cavities are often multiple 3.
Successful treatment leads to thinning of cavitary walls. Lesions heal with cicatricial atelectasis, scarring, fibrosis, and traction bronchiectasis 2.