A 42-year-old woman working at a poultry farm complains of dyspnea, thoracic pain on the left, increased body temperature up to 38-39°C in the evening, and cough. The patient suffers from essential hypertension. Objectively: vesicular respiration in the lungs, vesicular resonance without alterations. X-ray of both lungs reveals numerous small low-intensity foci, 2-3 mm in size, located in a row along the blood vessels. ESR - 32 mm/hour. What is the most likely diagnosis?

Answer options

1. Acute disseminated tuberculosis
2. Focal tuberculosis
3. Infiltrative tuberculosis
4. Community-acquired pneumonia
5. Pulmonary carcinomatosis

Explanation

A. Acute disseminated tuberculosis is characterized by severe signs of intoxication, cough, the formation of small low-intensity foci, 1-3 cm in diameter, which is in both lungs alongside blood vessels. B. Infiltrative tuberculosis is characterized by a focal shadow which is above 1 cm in diameter, but less than 3 segments (one lobe), which is in the upper segments S1 S2 of the lungs. C. Pulmonary carcinomatosis of the lung radiographically can be manifested by the appearance of single and/or multiple nodes (shadows), carcinomatous lymphangitis, pleuropneumonia, and military carcinosis. The most generic form of metastases is the rounded shape of the homogeneous nodes, with varying degrees of shadow intensity with a clear or wavy outline. Diameters of metastases vary from 0.3 to 12 cm, but the most frequent diameter of detectable nodes in the lungs is from 2 to 4 cm. Often, the appearance of metastases is accompanied by an inflammatory response of the basal and mediastinal lymph nodes in the form of their increase in size.D. Focal (nodular) tuberculosis is characterized by nodular shadow up to 1 cm in diameter. E. Community-acquired pneumonia often extends to one or two bronchopulmonary segments and usually has a one-sided character. Bilateral changes in non-hospital pneumonia are rare. According to the indicated clinical signs of severe intoxication and X-ray characteristics of pulmonary pathology (spread the bilateral location of small low-intensity, 2-3 mm in diameter shadows alongside blood vessels), the patient has acute disseminated tuberculosis.