CTICasesPulmonary Tuberculosis with a Dominant Cavitary Lesion
Imaging findings
Chest CT demonstrates a highly asymmetric, multifocal process with numerous small, centrilobular nodules in a peribronchovascular and subpleural distribution. A dominant, large, cavitary mass-like lesion containing internal calcification is present in the right lung. On follow-up CT, some of the initial nodules have slightly regressed, but new, active centrilobular nodules, branching "tree-in-bud" opacities, and consolidations have developed in the left upper lobe and right lower lobe.
Key takeaways
While sarcoidosis can present with mass-like lesions and nodules in a peribronchovascular distribution, a dominant cavitating lung mass without significant cicatricial volume loss or architectural distortion is highly atypical for sarcoidosis and should immediately raise suspicion for an infectious etiology like tuberculosis. The development of new, asymmetric, centrilobular nodules and tree-in-bud opacities on follow-up imaging in a patient from a high-risk environment (such as a correctional facility) strongly supports active, transbronchial spread of mycobacterial infection.
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