What is your diagnostic hypothesis?
It was a progressive pulmonary tuberculosis associated with bronchial
dilatation.
Indeed, the sputum examination for acid-fast bacilli was positive.
Furthermore, the cyto-bacteriological examination of the sputum revealed
a bacterial superinfection with Staphylococcus sp. The human
immunodeficiency virus serology was negative. The thoracic CT scan,
performed to confirm the dilatation of the bronchi and to eliminate
differential diagnoses, showed diffuse bronchial dilatations in the left
lung, in varicose and sometimes cystic forms (Figure 2A) associated with
a large excavation with a thick wall, occupying almost the entire upper
lobe, suggestive of tuberculosis cavity. On the right, localized
cylindrical bronchial dilatations were noted, associated with
micronodular opacities with a tendency to coalescence in the upper lobar
part, giving the typical budded tree appearance of pulmonary
tuberculosis (Figure 2B).