CTICasesPost-Primary Tuberculosis with Chronic Right Middle Lobe Collapse
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Imaging findings
Initial imaging revealed right middle lobe collapse along with tree-in-bud opacities and larger nodules in the anterior basal segments of the right lower lobe. Calcified lymph nodes were noted at the orifice of the middle lobe bronchus, and a large subcarinal lymph node was also present. After 10 months of therapy, the lower lobe nodules cleared, but the right middle lobe remained chronically collapsed.
Key takeaways
This case demonstrates post-primary tuberculosis manifesting with both active infection (tree-in-bud and nodules in the lower lobe) and chronic airway obstruction. The chronic right middle lobe collapse resulted from old tuberculous lymphadenitis causing occlusion of the middle lobe bronchus, highlighting the long-term sequelae of granulomatous inflammation on airways. The patient's response to therapy for the active infection was successful, but the chronic collapse persisted.
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