Presentation
Recently immigrated to the US. Chronic productive cough for the past 3 months.
Patient Data
There is an air-filled cavitary lesion with thick walls in the right lower lobe just above the level of the diaphragm. Streaky and patchy opacification is seen adjacent to this lesion within the right middle and lower lobes.
There is a large thick-walled cavitary lesion in the basilar segment of the right lower lobe. The cavity is air-filled without a fluid component. A second smaller thick-walled cavity in the medial segment of the right middle lobe. Adjacent patchy and confluent areas of atelectasis are present around both lesions.
In the right lower lobe, there is extensive cylindric bronchiectasis. No bronchiectatic airways are seen in the right upper lobe or left lung.
There are scattered small nodules and tree-in-bud opacities within the anterior segment of the left upper lobe, anterior segment of the right upper lobe, right middle lobe, and right lower lobe. Punctate calcifications are present within an area of parenchymal opacity in the right lower lobe.
Right hilar and subcarinal lymphadenopathy is seen.
Case Discussion
This is a case of progressive primary pulmonary tuberculosis with lower lobe destructive cavitating pneumonia and endobronchial spread.
The patient was seen by pediatric pulmonary who initially performed an interferon gamma release assay, which was positive. Sputum samples were then tested which revealed acid-fast organisms, consistent with tuberculosis. No complications arose during her treatment course.
Co-author: Richard Lee
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