Answer

Pulmonary tuberculosis

There are confluent ill-defined areas of consolidation in the mid- and upper zones of both lungs. Given the appearance and distribution of the changes, pulmonary TB has to be a primary consideration. Altered immunity from HIV should be considered (Table 1.14).

Table 1.14 Chest X-ray manifestations of TB

■ Primary pulmonary TB

• Air space consolidation 1-7 cm diameter

• Lymphadenopathy: hilar, paratracheal

• Pleural effusion

• Segmental consolidation

• Cavitation

• Calcified ghon focus

• Calcified lymph nodes

■ Post-primary TB (reactivation or initial infection or infection post-BCG)

• Apical and posterior segments of upper lobes

• Chronic patchy ill-defined areas of opacification

• Cavitation may colonise with Aspergillus

• Bronchiectasis

Fig. 1.74 TB upper lobe fibrosis. There is linear shadowing and volume loss in both upper zones with elevation of both hila.

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