CTICasesPulmonary Tuberculosis with Bronchial Obstruction in a 5-Year-Old
Imaging findings
The earliest radiograph in a 5-year-old shows lymphadenopathy and lower zone consolidation, with right middle lobe collapse confirmed on the lateral view. Two months later middle and lower lobe collapse are both present, an appearance that can mimic pleural disease. CT demonstrates extensive mediastinal and bilateral hilar lymphadenopathy together with a prominent thymus, compromise of the bronchus intermedius with gas resuming distal to it, and a large necrotic node adjacent to the airway. The collapsed middle lobe lies anteriorly and the lower lobe posteriorly, and inhomogeneous lucency within the lower lobe suggests an abscess or collection of pus.
Key takeaways
Progressive lobar collapse with bulky lymphadenopathy in a child over a two-month interval is not an acute process and should raise tuberculosis. The bronchial obstruction here appeared to result from external crowding by an adjacent necrotic node rather than from disease within the airway lumen, and the affected lobes eventually re-expanded. Lucency within a collapsed lobe suggests superimposed abscess or pus rather than simple collapse.
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