Tuberculosis Study Guide - M.M. Savula 2002

Disseminated pulmonary tuberculosis
Subacute disseminated pulmonary tuberculosis

This form is also classified as a progressive form of tuberculosis. It occurs in debilitated individuals, alcoholics, drug addicts, elderly patients, and those undergoing long-term corticosteroid therapy. Large foci (up to 1 cm) form in the Lungs, prone to coalescence and caseous necrosis, with subsequent formation of multiple cavities.

Clinical presentation, Diagnosis. The disease onset is gradual or acute, mimicking Influenza or Pneumonia.

Patients present with elevated body Temperature (initially low-grade, later high), sweating that can progress to profuse diaphoresis, decreased appetite, and weight loss. Bronchopulmonary symptoms are observed: cough, sputum production, dyspnea, occasional chest pain, and hemoptysis. Broad-spectrum antibiotic therapy is ineffective or yields only minor, temporary improvement. Sometimes, the first symptoms of the disease are pain on swallowing and hoarseness resulting from laryngeal tuberculosis, or signs of Pleurisy, renal, or bone tuberculosis may appear.

Physical examination often reveals weight loss, pale Skin, dullness to Percussion symmetrically over the upper and middle lung fields, harsh breath sounds, and fine or medium moist crackles, sometimes dry wheezes. Peripheral Blood analysis shows leukocytosis, sometimes up to 15-17- 109/l, lymphopenia, and elevated ESR. The Mantoux test is positive. MBT is frequently detected in the sputum.

Chest X-ray reveals large, coalescent foci symmetrically in the upper and middle fields of both lungs ('falling snow flakes' pattern) (Fig. 17). Against this Background, radiolucent areas of cavity formation rapidly appear.

Untreated subacute disseminated tuberculosis progresses steadily and leads to a fatal outcome within 5-7 months. Following Treatment, complete resolution of the foci is usually not observed, and residual fibrotic changes develop. Occasionally, the process transitions into Fibrocavitary Pulmonary Tuberculosis.

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Fig. 17. Chest X-ray. Disseminated pulmonary tuberculosis (subacute).



Last update: 10/08/2026

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