17584              DIFFUSE TUBERCULOUS PNEUMONIA

The patient was a woman aged 49.  She had been weak and tired easily for some time and shortness of breath had been present and increased for the previous 6 months.  Three weeks before admission she developed night sweats and fever with a non-productive cough.  She was admitted to hospital and chest X-ray showed pneumonic consolidation of the right upper lobe.  This pneumonic consolidation failed to resolve and scattered opacities appeared throughout both lung fields.  Sputum examination at this stage revealed many acid-fast bacilli.  After two weeks in hospital her condition deteriorated rapidly and she developed congestive cardiac failure and died.  At postmortem there was advanced bilateral pulmonary tuberculosis.  the left lung showed patches of tuberculous bronchopneumonic consolidation maximal in the posterior subapical region of the upper lobe.

The specimen is of the right lung.  There is a small acute tuberculous cavity 2 cms in diameter in the subapical region.  It has not obviously encapsulated.  Surrounding it there is diffuse lobar consolidation with caseous necrosis visible in some areas.  The lower lobe similarly shows confluent pneumonic tuberculous consolidation.  In the anterior basal segment of the lower lobe and in the middle lobe the bronchopneumonic patches are smaller and more discrete.  There is some overlying fibrinous pleurisy.  Histology shows typical tuberculous granulomatous reaction.  The apical cavity contains very large numbers of acid-fast bacilli.