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In active pulmonary TB, infiltrates or consolidations and/or cavities are often seen in the upper lungs with or without mediastinal or hilar lymphadenopathy. [1] However, lesions may appear anywhere in the lungs. In HIV and other immunosuppressed persons, any abnormality may indicate TB or the chest X-ray may even appear entirely normal. [1]
A pulmonary infiltrate is a substance denser than air, such as pus, blood, or protein, which lingers within the parenchyma of the lungs. [1] Pulmonary infiltrates are associated with pneumonia, tuberculosis, [citation needed] and sarcoidosis. [2] Pulmonary infiltrates can be observed on a chest radiograph. [citation needed]
During initial stages, this is most often found in the lower lobes, although involvement of the upper lobes and right middle lobe has also been reported early in the disease course. [ 16 ] [ 18 ] This is in contrast to the two similar coronaviruses, SARS and MERS , which more commonly involve only one lung on initial imaging.
People who aspirate while standing can have bilateral lower lung lobe infiltrates. The right upper lobe is a common area of consolidation, where liquids accumulate in a particular region of the lung, in alcoholics who aspirate in the supine position. [15]
Location: Upper lobe location is a risk factor for cancer, while a location close to a fissure or the pleura indicates a benign lymph node, [8] especially if having a triangular shape. [9] Margin morphology: a spiculated margin is a risk factor for cancer. [8]
Sagittal reformat from a CT scan of the chest showing air crescent sign in a patient with invasive fungal infection. There is a rounded cavity in the apical right upper lobe, with a non-dependant soft-tissue nodule within it. Also there is some subtle ground-glass opacity surrounding the lesion.
A chest X-ray will show fluid in the alveolar walls, Kerley B lines, increased vascular shadowing in a classical batwing peri-hilum pattern, upper lobe diversion (biased blood flow to the superior parts instead of inferior parts of the lung), and possibly pleural effusions. In contrast, patchy alveolar infiltrates are more typically associated ...
Clinical tests include chest radiography or (HRCT) which may show centrilobular nodular and ground-glass opacities with air-trapping in the middle and upper lobes of the lungs. Fibrosis may also be evident. Bronchoalveolar Lavage (BAL) findings coinciding with pneumonitis typically include a lymphocytosis with a low CD4:CD8 ratio. [7] [13]