Presentation
Chronic cough, night sweat and shortness of breath on exertion.
Patient Data
Upper zone predominant patchy opacity containing multiple lung cavities in the upper zones and left lower zone. Small right pleural effusion. Heart size is normal.
Multiple peripherally enhancing cavitating lung lesions in both upper lobes and left lower lobe. The largest is in the apicoposterior segment of left upper lobe. No fluid levels.
Diffuse centrilobular nodules with "tree in bud appearance" in both lungs especially in both upper lobes, the left lower lobe and the superior segment of right lower lobe.
Corrugated airways with abnormal bronchodilatation in keeping with traction bronchiectasis in both upper lobes.
Minimal left pleural effusion.
No lymphadenopathy.
A hypodense liver lesion at segment VII.
Case Discussion
Sputum and smear were positive for acid fast bacillus mycobacterial tuberculosis. Patient has underlying retroviral disease (immunocompromised) which predisposes patient to opportunist lung infections including tuberculosis.
The distribution of lung opacities, nodules and cavities to be predominant in the upper lung lobes are typical for the post primary pulmonary tuberculosis.
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