Image Based Question-71061

A 45-year-old woman with poorly controlled diabetes mellitus, presented with productive cough for 1 month. She also noticed low grade fever, night sweating and weight loss during this period.

Examination of the chest showed a dull percussion note, decreased air entry and coarse crepitations in the right upper zone.

Laboratory investigations revealed raised ESR, normal white cell count and a CXR was performed.What is the radiological diagnosis?

A. Lung Abscess

B. Empyema

C. Tuberculosis

D. Bronchiectasis

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Correct Answer » C Explanation

Ans:C. Tuberculosis

Image shows: Frontal chest radiograph showing air-space opacification in the right lung with cavitating lesions (arrows)

due to caseous necrosis in tuberculosis.

Pulmonary tuberculosis

• The cavitation and air-fluid level within the opacity represents caseous necrosis in tuberculosis.

• The involvement of the apex is a clue towards the diagnosis of TB as post-primary TB has a predilection for the lung apex

Discussion

• Other radiological findings of pulmonary TB not seen in this patient include:

1. Enlarged hilum – representing granulomatous inflammation of lymph nodes, usually in primary TB
2. Fibrocalcific changes in lung apex usually representing healing of previous TB infection
3. Multi-focal air-space opacities representing bronchogenic spread of infection .
4. Tiny miliary nodules in both lungs representing miliary TB due to haematogenous spread of infection