Fig. 2

Panel g. Multiple focal pulmonary nodules. Multiple focal pulmonary nodules involving the right middle lobe with enlargement of regional lymph nodes (right lung). Panel h. Cavitary (“adult-type”) pulmonary disease. Cavity formation in both upper lobes, with endobronchial spread to the right middle lobe. Nodules or cavities in apical lung segments are typical of adult-type disease and are pathologically distinct from the other cavities shown. Panel i. Bronchitis and endobronchial granulomas. Inflammation of the mucosa of main stem bronchus with purulent secretions (left lung), and a necrotic lymph node that has eroded into the right middle lobe bronchus leading to endobronchial spread and subsequent development of endobronchial granulomas extending proximally to the bronchus intermedius and main stem bronchus, and distally to the lower lobe bronchus (right lung). These findings are best visualized by bronchoscopy. Panel j. Bronchiectasis and tree-in-bud-pattern. Bronchiectasis that extensively involves the upper lobe (right lung), and shows tree-in-bud pattern observable on CT scans -- reflecting dilated centrilobular bronchioles with mucoid impaction -- involving the upper lobe (left lung). Panel k. Pleural effusion. A pleural effusion that is usually indicative of recent primary infection, with a hypersensitivity response to tuberculoprotein leaking from a subpleural Ghon focus (often not visible) into the pleural cavity; in rare cases this effusion may also result from a chylothorax. Panel l. Pericardial effusion. A pericardial effusion that occurs when tuberculoprotein leaks from a necrotic subcarinal lymph node (shown in “close-up” window) into the pericardial space; it may also occur after hematogenous spread. Conceptualization and original sketches by C.L. Roya-Pabon, MD; finished artwork by Mesa Schumacher, MA (used with permission). Adapted from C.M. Perez-Velez. Diagnosis of Intrathoracic Tuberculosis in Children. In: Handbook of Child and Adolescent Tuberculosis (p. 154–155), J.R. Starke and P.R. Donald (Eds.), 2016, New York, NY: Oxford University Press. Copyright by Oxford University Press [15]. Adapted with permission