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Joseph Cannella, MS4

Dr. Christina LeBedis, MD, MS

50-year-old male with a past medical history significant for ESRD on HD, HFrEF (40-45%) and OUD presents to the ED with 2 months of SOB and hemoptysis. Pt also endorses an unintentional 40 lb weight loss with night sweats over the past 2-3 months.

Initial labs were notable for a WBC of 13.5

Reactivation TB
CXR reveals a dense consolidation in the right upper lobe (red arrow) with questionable air-fluid level. No pneumothorax. No pleural effusions. Differential includes right upper lobe pneumonia or tuberculosis. CT is recommended for further evaluation if there is concern for a cavity.
Courtesy Joseph Cannella,
Dr. Christina LeBedis, MD, MS
CTPA reveals a large consolidation in the right upper lobe and superior segment of the right lower lobe spans approximately 8.8 x 5.6 x 9.4 cm and extends to the pleura. There are multiple internal cavitations (red arrows) with air-fluid levels. These large predominately right upper lobe cavitary lesions are consistent with clinical concern for tuberculosis pneumonia, however follow-up with chest CT in 3 months post-treatment is recommended to exclude other less likely causes of cavitary lesions, such as malignancy.
Courtesy Joseph Cannella,
Dr. Christina LeBedis, MD, MS
  • Mycobacterium tuberculosis complex direct PCR was positive.
  • Mycobacterium sputum culture was positive.
  • Patient was admitted to the infectious disease service and started on antibiotic therapy.
  • Following initiation of R.I.P.E therapy, the patient showed improvement in RUL cavitary size and follow-up was scheduled to continue monitoring outpatient antibiotic regimen and RUL lesion.