12623              DISSEMINATED PULMONARY TUBERCULOSIS

The patient was a man aged 52 who had been losing weight for a year.  On admission there was a severe cough which had been present for 3 weeks together with malaise and marked anorexia.  Chest X-ray showed gross scattered opacities throughout both lung fields. Acid-fast bacilli were present in the sputum.  He was admitted to the tuberculosis annexe and died after 5 weeks.

The specimen consists of the sectioned lungs and respiratory passages.  There is a small encapsulated caseous focus at the left apex towards its menial side, lying beneath a large flat apical scar.  This appears older than the other lesions and may be a primary focus.  Below this there are a few small foci only a few mms in diameter in the upper lobe.  There is a large cavity filled with caseous exudate in the apical segment of the lower lobe.  This cavity measures about 5 x 3 cms.  Beneath it there are many scattered large rosettes and caseous masses representing acute bronchopneumonic spread.  In the right lung there are 4 groups of confluent caseous nodules which also represent bronchopneumonic spread.  Excavation is commencing in the right upper lobe.  Histology showed acute caseating tuberculous pneumonia with occasional giant cells and many acid-fast bacilli.