Pulmonary tuberculosis
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.