Figure 66A: Posteroanterior (PA) and lateral chest films show a heterogeneous opacity with bronchiectasis and cavities/cysts in the right upper lobe (yellow arrows), as well as elevation of minor fissure and superior retraction of right hilum.

Postprimary tuberculosis, lung cancer, sarcoid.

Parenchymal involvement in postprimary TB most commonly manifests as heterogeneous opacities in the apical and posterior segments of the upper lobes, and in the superior segment of the lower lobes, along with bronchiectasis, architectural distortion, calcifications, and residual cavities.1,2 Predilection of postprimary TB to involve the upper lobes is likely caused by the relatively higher oxygen tension and less robust lymphatic drainage. Because architectural distortion and calcifications may be present in both nonactive and active disease, determination of active TB infection based on radiographs alone is not possible, and must be confirmed by sputum culture,3 as was done in this patient.