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Next, I'll show you a couple of cases of mycobacterial

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or tuberculosis infection.

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The findings in TB can vary quite a bit depending on

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what stage of the disease process the patient is in.

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And also there are a variety

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of findings in the disease itself.

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In primary tuberculosis, frequently you can expect

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to see lymphadenopathy, particularly in the hilar

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and para tracheal regions.

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And one distinguishing feature

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or common feature is

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that the lymphadenopathy will have central necrosis.

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So if you have IV contrast on board,

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you can see central hypo density

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with peripheral rim enhancement.

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But in the primary phase, you can also see consolidation

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of lung, sometimes cavitation,

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although that's more common in post-primary tb,

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and you may also see pleural effusions in

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post-primary tb.

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There's a predilection for apical

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and superior segment, lower lobe

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consolidation possibly with cavitation.

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Frequently we see tree and butt opacities

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and central lobular nodules,

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and sometimes you can see tuberculosis which are soft tissue

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or calcified nodules in the lungs.

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This is a patient with post-primary TB

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with multiple findings.

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We have in lung window axial and sagittal sequences.

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We'll focus here on the axials. First.

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Starting up in the apices we can see on that right side

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numerous tree and bud opacities.

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Areas of consolidation, superimposed cavitation

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and similar findings elsewhere as well.

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Particularly on the left side, the superior segment

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of the left lower lobe.

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We again see numerous tree

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and bud opacities as well as some cavitation.

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Within that upper portion, we see tree

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and bud opacities scattered about in other lobes as well.

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But the right apex

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and the superior segment left lower lobe are

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what are most affected in this particular patient.

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We also see some little subpleural nodules scattered

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around as well.

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Looking at the sagittals, just to compare, we can see on

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that right side the majority

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of the findings we already discussed,

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including cavitation in that apex,

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but also additional regions of tree and

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but opacities and consolidation.

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As we move to the contralateral left side, we can see

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that superior segment left lower lobe with findings

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to include cavitation high up.

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This patient also has a radiograph,

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which you do not have in your viewer,

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but just so you're aware, you can see many

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of these same findings on radiographs,

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particularly if you have a patient

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with a presenting radiograph with what looks like a lucency,

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especially with a flat air fluid level,

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you should be highly concerned

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for cavitation due to some reason.

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The other patient, I will start

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With the radiograph.

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This patient came in with infective symptoms

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and was noted to have both

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a consolidation in the left mid lung silhouetting,

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the left cardiac margin, making it likely

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to be in the lingula, and we see similarly

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increased density in the region

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of the lingula on the lateral.

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Importantly also, this patient has a more

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prominent right para tracheal soft tissue nodular opacity.

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And if you didn't have the clinical history of tuberculosis

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infection, this could conceivably be a bacterial pneumonia

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in the lingula with some reactive lymphadenopathy.

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However, this patient went on to have

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a CT scan starting

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with this axial contrast enhanced soft tissue window ct.

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We can see obviously the consolidation in the lingula,

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and importantly, it is not uniformly

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enhancing consolidated lung.

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We can see that there are areas of necrosis within it

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that are non enhancing or hypo enhancing.

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And then additionally, we see multiple regions

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of lymphadenopathy in the mediastinum, including in

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that upper right para tracheal region.

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Corresponding with the radiographic images,

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we can see on the coronal images, similar findings.

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There's that consolidation in the lingula with the areas

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of central necrosis

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and then the multifocal lymphadenopathy, including in

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that right per tracheal region.

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You can see more easily on this coronal image how

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that lymphadenopathy seems to also have central hypodensity

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or central necrosis with more peripheral enhancement.

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So these are all findings that fit with tuberculosis.

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Additionally, this patient on lung windows

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has a cavitary lesion in the lower lobe

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that we didn't appreciate on the soft tissue windows.

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In retrospect, you go back to the radiograph,

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that's probably that nodule right there

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with a really subtle air fluid level in the middle.

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So all features that we can see in tuberculosis.