The CXR shows bilateral upper lobe infiltrates with cavities, suggestive of active pulmonary tuberculosis. In general, thin-walled cavities (<5 mm) tend to be infective and, when thick-walled (> 10 mm), squamous cell carcinoma of the lung enters into the differential diagnosis. Tuberculosis tends to afflict the upper lobes and apical segment of the lower lobes. However, within the upper lobe, anterior segment involvement is rare. Diagnosis is confirmed by obtaining sputum and staining with fluorochrome or Zeil Nielson and culturing with Lowenstein Jansen media. Cavitary upper lobe disease has good correlation with a sputum positive smear and hence is extremely infectious. Other differential diagnoses of cavitary pulmonary lesions include infections from Staphylococcus, Klebsiella, anaerobes, and non-infectious causes like squamous cell carcinoma of the lung, pulmonary infarcts, Wegener's granulomatosis, and rheumatoid nodules.
Case 9. This 80-year-old male used to work in a sand quarry. He was asymptomatic. His CXR is shown (Fig. 9.1). What is the diagnosis?
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