CTICasesPost-Primary Tuberculosis with Concurrent Adenocarcinoma
Imaging findings
Initial radiograph shows diffuse nodularity, volume loss, scar, and bronchiectasis in the left upper lobe, with a possible second nodule in the right upper lobe. CT confirms left upper lobe findings consistent with tuberculosis, presenting as small granulomas, some with airway-centric (tree-in-bud) opacities, and a distinct right upper lobe nodule. Follow-up CT after TB treatment shows resolution of the left upper lobe infiltrates with residual scarring and bronchiectasis, but interval enlargement of the right upper lobe nodule, consistent with adenocarcinoma.
Key takeaways
Tuberculosis can present with atypical patterns like small granulomas mimicking sarcoid-like "galaxy sign" or reverse halo signs with micronodules, rather than classic consolidation. It's crucial to consider concurrent pathologies, especially lung cancer, even in the setting of active infection. Follow-up imaging after TB treatment is important to ensure resolution and monitor other findings.
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