Radiology Teaching Files > Case 8453675

Contributed by: el kharras abdennasser, Radiologist, Faculty of Medicine, Rabat, Morocco.
Patient: 38 year old male

The patient presented with a one -month history of malaise, anorexia and dyspnea without any improvement after antibiotic therapy. Chest radiographs, abdominal ultrasound and CT of the chest were achieved.  




Fig. 1: Frontal radiograph shows the cavitation in the apical segment in the left upper lobe.

Fig. 2: High-resolution CT scan shows a relatively thin-walled cavity with even thickness in the superior segment of the left lower lobe. Note the bronchial communication.

Fig. 3: Sagittal reconstruction

Pulmonary tuberculosis is classically divided into primary and post primary forms. The first tipically manifests radiologically as parenchymal disease, lymphadenopathy, pleural effusion, miliary disease or atelectasis. The radiologic features of post primary tuberculosis can be broadly classified as parenchymal disease with cavitation, airway involvement, pleural extension and other complications.

The cavitation is very frequent; represent the 2/3 of the radiological aspects of the tuberculosis post primary. They are the result of the caseum necrosis that is evacuated it self by a bronchus, giving birth in a tubercular cave. They indicate a high likelihood of activity. Endobronchial spread is the most common complication of tuberculous cavitation.

The cavitation presents itself like an excavation in generally thick and irregular partition. One describes a bronchus of drainage and a level classically hydro aérique. The bacteriological diagnosis is comfortable because the expectorations are rich in BK, recovered in 98% of the cases. CT examination of the chest (especially HRCT) is the method of choice for the evaluation of tuberculous cavitation because of the low sensibility of conventional chest X-ray. The CT chest find in post primary tuberculosis is the development with a predilection for the apical or posterior segment of the upper lobes or the superior segment of the lower lobes. More than one segment are involved in most cases. High-resolution CT (HRCT) is sensitive in its detection, showing small, poorly defined centrilobular nodules and branching centrilobular areas of increased opacity.


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Additional Details:

Case Number: 8453675Last Updated: 03-16-2007
Anatomy: Chest   Pathology: Infection
Modality: CT, Conventional RadiographAccess Level: Readable by all users

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