PMC6446130_01
Posteroanterior and lateral chest roentgenography showing left suprahilar lucency.
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The chest x-ray, Fig. 1, had a lucency in the left suprahilar region and bilateral peribronchial thickening of the upper lobes.
Transverse and coronal CT chest showing multiple cavitary lesions.
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A follow up CT scan, Fig. 2, showed multiple cavitary lesions at the superior segment of the left lower lobe.
Pathology of pulmonary TB involving the left lower lobe. A-B. Necrotizing non-suppurative granulomatous and chronic inflammation in a miliary pattern (arrows and asterisk: caseous necrosis, dashed frame: area displayed on B, H&E stain, 25x). C. Obliterative endarteritis (Verhoeff elastic stain, 100x). Granulomas (asterisk) disrupted the wall and elastic fibers of an artery (small arrows) inducing a reactive intimal proliferation (two headed arrow). D-F. Granulomas complicated with parenchymal necrosis (asterisk, D), cavitation (arrows, D) and hemorrhage due to vascular erosions (dashed frame: area displayed on F, Verhoeff elastic stain, 200x; arrow: duplication of inner elastic lamina of an artery). G-I. L-shaped mycobacteria on FITE stain, 600x.
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There was widespread consolidation with nodules containing caseous material, Fig. 3A. It corresponded to necrotizing nonsuppurative granulomas with a peribronchial and subpleural distribution in a miliary pattern, Fig. 3B. The granulomatous inflammation extended around medium sized vessels causing destruction of the vasa vasorum and secondary obliterative endarteritis, Fig. 3C. Numerous cavities developed in relation to necrotizing granulomas with suppuration and hemorrhage, Fig. 3D. Fig. 3E and F. Few acid-fast organisms consistent with L-shaped mycobacteria were identified on FITE stain, Fig. 3G-I.