PMC6683832_01
Lateral cervical area of patient with swollen and draining lymph nodes.
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On examination, the patient, a tall and thin man, (BMI = 19.6 Kg/m2), with normal skin color, had a normal physical appearance except for his left lateral neck lesion including draining tract sinuses with purulent material (Figure 1) and scarce low-pitched expiratory wheezes.
Chest CT image showing small (3 mm) nodules (black arrow) in the apical-posterior segment of the left upper lobe.
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The computed tomography (CT scan) showed minimal fibrous bands in the upper zone area of the right upper lobe, while a small calcified nodule (3 mm diameter) was also found in the periphery of the apical-posterior segment of the left upper lobe (Figure 2).
Small area with anthracotic discoloration (black arrow) in the posterior segment of the right upper lobe.
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Fiberoptic bronchoscopy revealed a diffusely red and hyperemic bronchial mucosa, particularly intense in the segments of the right upper lobe, with the presence of some small anthracotic areas (Figure 3).
(a) Tuberculous granuloma with collections of epithelioid macrophages (thin two-direction black arrow) and Langhans giant cells (simple thick black arrow) H-EX400. (b) Central coagulative necrosis (thin two-direction black arrow) with a rim of epithelioid cells ("lightning" black arrow) H-EX100.
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Final diagnosis for TL was established by histopathologic examination (Figures 4(a) and 4(b)).