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Post-primary pulmonary tuberculosis :. There is a considerable range in clinical severity from symptomless to "galloping consumption" (a term used to describe an acute caseating lesion with gross cavitation). Symptomless lesions are often nodular shadows or small areas of infiltration seen in the apices or upper lobes. Occasionally a small pleural effusion may be detected on a routine film. Common symptoms are persistent cough, haemoptysis (usually recurrent and minor), malaise, fever and weight loss. Occasionally there may be purulent sputum production or chest pain. It is important to be aware of the possibility of tuberculosis when patients complain of these symptoms, especially a cough that persists for more than one month, or if a patient has pneumonia which fails to respond to antibiotics. Elderly patients may present with non-specific symptoms such as malaise, weight loss, and confusion. Fever may not always be present and the diagnosis of tuberculosis may be missed. Physical signs are often absent. Crackles may occur, especially after coughing. Chronic fibrotic disease may produce various signs including: reduced expansion, dullness to percussion, bronchial breathing at the apex, tracheal deviation.
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