This patient had a clinical history of weight loss a year ago with multiple hospitalizations for pneumonia and severe malnutrition without any improvement despite broad-spectrum antibiotic treatment; later, she started with lower limb edema and dyspnea, so her decision was made. Transfer to a first-level hospital where they carry out evaluation and their complementary studies. On physical examination, a suppurative lesion is observed in the right supraclavicular region, considered cervical lymphangitis and known as scrofula; in the lungs, a decrease in the air intake in the right basal region is auscultated with dullness on percussion. Hepatomegaly and lower limbs with marked edema are palpable in the abdominal region.

She is presented to the Pediatric Radiology Department, where she undergoes imaging studies showing completely opacified hemithorax in the chest x-ray with some radiolucent areas, without air bronchogram and without displacing contralateral structures. A chest tomography with the same characteristics with hypodense areas that is part of the healthy parenchyma. Subsequently, a bronchoscopy was performed, isolating Mycobacterium tuberculous, treatment was started, but unfortunately, the patient died a day later.

Tuberculosis is an infectious disease caused by mycobacterium tuberculosis, an acid-resistant bacillus. Tuberculosis is transmitted via the respiratory route by contaminated droplets. Children eliminate few bacilli through respiratory secretions, so they do not usually transmit the infection. Lymphadenopathy with or without concomitant pulmonary involvement represents the most important sign of primary tuberculosis in childhood, with the right lung being the most affected by 70%, such as the case presented. Differential diagnoses of a hemithorax white -out can be considered pulmonary agenesis, pulmonary hypoplasia, effusion pleural, chest wall mass, diaphragmatic hernia.