A 38 year old female who has recently entered the country is referred by a GP with increasing cough, fevers and sweats.
Describe and interpret this CXR
CHEST X-RAY INTERPRETATION
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.