Anterior segment upper lobe tuberculosis in the adult. Occurrence in primary and reactivation disease

Nine patients with pulmonary tuberculosis involving predominantly or exclusively the anterior segment of one or both upper lobes were seen over a five-year period. The incidence of anterior segment upper lobe tuberculosis was 6.3 percent of 142 patients presenting with pulmonary tuberculosis during the same time period. Five of the nine patients with anterior segment upper lobe involvement had reactivation disease. An increased incidence of advanced age, diabetes, associated malignant neoplasms, alcoholism, and steroid use were noted in those patients with anterior segment involvement, although only the occurrence of diabetes was statistically significant. We suggest vigilance with regard to the diagnosis of tuberculosis in patients who are elderly, diabetic, or alcohol abusers, particularly where the roentgenographic appearance of anterior segment upper lobe involvement would tend to favor an alternative diagnosis.