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.
8 thoughts on “Cáceres’ Corner Case 241 – SOLVED”
Right lower lobe consolidation /mass
Prominent right paratracheal region by soft tissue density area ? LN
Not all cases with enlarged nodes are lymphoma 🙂
Lobar pneumonia in the right lower lobe.
CHEST XRAY PA AND LATERAL VIEW
1. Non-homogenous opacification in the right lower zone of concern for CONSOLIDATION.
2. Prominent right paratracheal stripe – ? enlarged lymphnodes, ? rotation.
To rule out COVID 19 – Basal involvement.
Wait for the CT images
Necrotic lymphnodes with right lower zone consolidation (endobronchial spread of infection
D/D – Tuberculosis to be rule out.
primary pulmonary Tuberculosis
Right lower lung lobe consolidation with air bronchogram, bounded by oblique fissure superiorly, in keeping with right lobar lung lobe pneumonia.