Orris
attachment
attachment

Before and after x ray, tell diagnosis

Reading File
analyse_media
Finding Sources
Searching PubMed

"tuberculosis, pulmonary"[MeSH Terms] AND "radiography, thoracic"[MeSH Terms]

Most likely diagnosis: extensive right-sided cavitary pulmonary tuberculosis (post-primary or reactivation TB), probably fibrocavitary, with bronchogenic spread. I can't confirm this from the films alone.
My automated image analysis failed, so this is my own reading of the photo. The films are dated 29.10.2013 and 11.11.2013. The "Л" marker sits on the right side of each image, so the standard orientation applies and the abnormal lung is the patient's right.
First film (29.10.2013)
  • The right upper and mid zones show multiple patchy, nodular and confluent opacities with several thick-walled lucencies. These are cavities.
  • The right lower zone shows scattered small nodular and patchy opacities. This pattern is typical of endobronchial (bronchogenic) spread.
  • The left lung looks relatively clear and hyperlucent. The mediastinum is slightly pulled toward the right.
Second film (11.11.2013, two weeks later)
  • The right upper zone is still dense, with persisting cavities and coarse, fibrotic-looking strands.
  • The upper lobe looks more contracted, and the trachea and mediastinum are pulled further to the right. This suggests fibrosis and volume loss.
  • The lower-zone disease is still present, and the left lung is still hyperinflated, probably compensatory.
  • This film has a different projection and exposure, so the interval change is hard to judge reliably. At best it looks stable to slightly worse, with no clear resolution.
Why TB fits
  • Upper-lobe infiltrates with cavitation, volume loss and spread to the lower zones are the classic post-primary TB pattern. Murray & Nadel's Textbook of Respiratory Medicine describes extensive upper-lobe cavitation as typical, and Goldman-Cecil Medicine shows the same picture as "Cavitary tuberculosis".
  • Little change over two weeks, and no sign of clearing, argues against a simple bacterial pneumonia.
Differential
  • Necrotizing pneumonia or lung abscess (Klebsiella, Staphylococcus, anaerobes)
  • Nontuberculous mycobacteria, whose radiographic appearance is similar to TB
  • Chronic pulmonary histoplasmosis or other fungal disease such as aspergilloma
  • Cavitating lung cancer, especially in a smoker
  • Granulomatosis with polyangiitis (less likely given the distribution)
What is needed to confirm
  • Sputum smear for AFB, plus culture and a rapid molecular test (Xpert MTB/RIF or similar) with drug-susceptibility testing, ideally on 3 samples
  • Chest CT if the diagnosis is uncertain, or to assess cavities and complications
  • HIV test, blood sugar and a clinical review (cough, hemoptysis, fever, weight loss, smoking, contacts)
  • Isolation until infectiousness is excluded, and bronchoscopy or biopsy if TB tests are negative and cancer is a concern
I didn't find any recent systematic review or meta-analysis that changes this imaging interpretation. This is an image-based impression, not a diagnosis, and the treating physician should confirm it with microbiology.
This is a shared conversation. Sign in to Orris to start your own chat.