PRIMARY PULMONARY TUBERCULOSIS

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Findings:

The examination from February 2002 is normal.However, right hilar and right paratracheal lymphadenopathy has developed in the setting of a positive PPD.



Diagnosis: Primary pulmonary tuberculosis.

Discussion:

Primary tuberculosis is the most common form of pulmonary tuberculosis in infants and children. However, its incidence has increased in adults, accounting for about 25% of all adult tuberculosis cases.The typical radiographic appearance of primary tuberculosis is parenchymal disease, lymphadenopathy, pleural effusion, miliary disease, or lobar or segmental atelectasis. However, approximately 15% of patients will have a normal chest radiograph.Primary pulmonary tuberculosis affects the areas of greatest ventilation, typically the right middle lobe, the lower lobes, and the anterior segment of the upper lobes. Other causes that may simulate tuberculous lymphadenopathy includes metastases and histoplasmosis in endemic areas.Fine, discrete nodular areas of increased opacity on chest radiographs is very suggestive of tuberculosis in the appropriate clinical setting. However, it may also be present in varicella pneumonia, sarcoidosis, histoplasmosis, metastases, pneumoconiosis, or hemosiderosis. At CT, primary tuberculosis typically manifests as air-space consolidation that is well-defined, dense, and homogeneous.