CTICasesPulmonary Tuberculosis Mimicking Traumatic Lung Lacerations
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Imaging findings
A trauma patient involved in a motor vehicle crash presented with a chest radiograph and trauma CT showing multiple cavitary lesions and surrounding nodules with a 'tree-in-bud' appearance in the left upper lobe, initially misread as contusion and lacerations. Despite negative PPD tests and sputum, follow-up imaging showed progression of the lesions. Later, the patient presented with classic 'B symptoms,' and sputum was floridly positive for tuberculosis.
Key takeaways
Radiologists should maintain a high index of suspicion for underlying infections like tuberculosis, even in trauma patients, especially when imaging findings are atypical for trauma or persist/progress. Classic patterns like 'tree-in-bud' opacities and cavitation should prompt investigation for infection, irrespective of initial negative tuberculin skin tests or sputum smears.
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