“Cough / hemoptysis”
This is what a typical TB cxr looks like to me. The cxr shows a patchy interstitial / reticulo-nodular pattern, but TB can pop up with alveolar infiltrates, cavitary lesions, etc. By TB, we usually mean secondary / reactivation TB. Primary TB usually shows up as alveolar / lobar infiltrates, like a typical bacterial pneumonia, with or without hilar adenopathy.
Most patients with cough and hemoptysis have a viral URI. It was fairly obvious that this patient had TB – he had many constitutional symptoms, weight loss, and he is an immigrant in an urban setting.
“Cough / pneumonia”
The patient had a PE with pulmonary infarct.
When you look at the CXR, there isn’t much there. The CXR shows a patchy infiltrate in the R base of the lung. It absolutely does not explain the patient’s R chest pain. When the CXR findings are discrepant with a reliable patient’s complaint, look further. We scanned the patient for a PE despite his normal vitals / O2 sat.
During flu season, it’s challenging to pick up these fake-out cases. Funny enough, we had a second patient that had “pneumonia” that turned out to be PE the very same week. The tamiflu he was given did not work for the PE.
