Today’s radiographs belong to a 24-year-old woman with cough and fever. What do you see?
More images will be shown next Wednesday and the answer will be published on Friday.
Showing today CT images of the chest. What do you think?
Click here to see the answer
Findings: Chest radiographs show air-space disease in the right lower lobe (A-B, arrows). There is marked widening of the right paratracheal line (A, red arrow) suggestive of mediastinal lymphadenopathy.
Axial CT with lung window shows RLL air-space disease without cavitation (C, arrow). Mediastinal window at different levels confirms enlarged paratracheal, subcarinal and neck lymph nodes with hypodense center (D-F, red arrows). These findings should suggest active tuberculosis as the first possibility.
Although TB usually affects upper lobes, isolated involvement of lower lobes occurs in about 7% of cases.
Mycobacterium tuberculosis was found in the sputum.
Final diagnosis: active TB.
Congratulations to Archanareddyt who was the first to make the diagnosis.
Teaching point: lymph nodes with hypodense center may occur in several processes (treated tumors, Whipple’s, etc.), but in the appropriate clinical situation, the first diagnostic consideration should be tuberculosis.