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).