What is the most common radiographic presentation of pulmonary tuberculosis?

• A. Cavitation
• B. Pleural thickening
• C. Hilar mass
• D. Hyperinflation

Answer: (A)

Cavitary disease in the upper lobes is the most common radiographic presentation of pulmonary TB. This pattern reflects reactivation of infection, which tends to localize in the apical/posterior segments of the lungs where oxygen tension is highest. The immune response causes granulomatous inflammation that undergoes caseous necrosis and forms cavities. These air-filled spaces, often with thick walls, may be solitary or multiple and can accompany adjacent consolidation or fibrotic changes. Cavitation indicates a higher bacillary load and greater contagiousness, which is why it’s the hallmark radiographic finding in many cases of pulmonary TB.

Other patterns like pleural thickening occur with pleural TB, hilar masses reflect lymphadenopathy (more typical in primary TB, especially in children), and hyperinflation is not characteristic of TB.