Primary Pulmonary Tuberculosis: An Uncommon Presentation

Primary Pulmonary Tuberculosis: An Uncommon Presentation

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1. Cough, fever, and malaise

A 53-year-old man has had
malaise, intermittent cough, and occasional
fever and night sweats for 2
weeks. He has also lost some weight
during this time but denies hemoptysis
and sputum production; he has
not traveled abroad recently. His only
significant medical condition is hypertension,
which is well controlled with

Temperature is 37.2oC (99oF);
heart rate, 88 beats per minute; respiration
rate, 18 breaths per minute; and
blood pressure, 135/84 mm Hg. Results
of cardiac, abdominal, and neurologic
examinations are normal. Breath
sounds are decreased in the middle
and lower lobes of the right lung.

You order frontal and lateral upright
radiographs of the chest. What
abnormalities are evident on these
films, and how will you proceed to
determine their cause?


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