CXR Case 038

There is diffuse air space shadowing with volume loss in the right upper lobe with an area of lucency suggesting a cavity.

There is volume loss, air space shadowing in the left lower lobe and possibly a small pleural effusion.

*There is external artifact overlying the left lung apex and clavicle.

There is consolidation, a lung cavity and pleural effusion.
These features are most likely caused by infection and TB should be strongly considered.

*This lady had come from Eastern Europe and had multi drug resistant TB.

While PCR can provide a positive rapid answer, the gold standard for excluding TB is three separate acid fast bacilli cultures to be negative.

*Mycobacteria can take up to 35 days to culture.

*Genetic analysis can provide resistance patterns although this is not widely available as yet.