22193              CHRONIC PULMONARY TUBERCULOSIS

This patient was a man aged 69 who was admitted with severe breathlessness and cough with yellow sputum.  X-ray showed bilateral small soft scattered opacities.  There were numerous acid-fast bacilli in the sputum.  Strict isolation measures were begun but the patient died on the 4th hospital day.

The specimen consists of the left lung sectioned to show a chronic tuberculous cavity 4 cms in diameter in the apico-posterior segment just beneath the pleura and against the upper end of the interlobar fissure which is obliterated by fibrous adhesions.  The remainder of the upper lobe shows marked destructive panlobular emphysema with anthracosis and there are some small scattered yellow tuberculous caseous foci.  The lower lobe shows destructive emphysema in the apical and anterior basal segments together with numerous scattered patches of acute caseous tuberculous bronchopneumonia throughout the lung field, particularly in the apical and posterior basal segments.  The overlying pleura shows some fibrous thickening.  Histology confirms acute tuberculous pneumonia with acid-fast bacilli.