Atypical radiographic appearance and clinical presentation of pulmonary tuberculosis

Fourteen patients with unusual presentation of pulmonary tuberculosis are described. Often, exposure to the tubercle bacillus was not apparent. In other cases, there was tuberculous infection or reactivation of a previous focus in individuals with altered immunity. The radiographic presentation often differed from the classic cavitating upper lobe disease. Persistent pneumonia, cavities, and nodules were seen in other areas of the lung including the anterior segments and the lung bases. Isolated effusion and solitary nodules were also evident. Increased suspicion of tuberculosis should be maintained when evaluating persistent parenchymal consolidation, effusion, and cavitating pulmonary disease.