CTICasesPulmonary Tuberculosis
Imaging findings
In an immigrant from a TB-endemic region of northern Africa, serial imaging over roughly a year and a half shows evolution from a solitary right upper lobe nodule without lymphadenopathy or effusion, to progressive lobar consolidation with cavitation and satellite nodularity, to extensive bilateral disease with tree-in-bud endobronchial spread, ultimately partially resolving on the most recent study after treatment was finally initiated.
Key takeaways
This case illustrates the smoldering, slowly progressive natural history of untreated pulmonary tuberculosis, evolving over roughly 18 months from an innocuous solitary nodule to extensive necrotizing, cavitary, airway-disseminated disease with reactive rather than necrotic-appearing adenopathy; the unusually large, dominant nodular component and chronicity initially raised concern for a fungal process rather than typical TB before the diagnosis was ultimately confirmed.
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