Of the 142 patients in the study group, 93 were men and 49 were women. Twenty-nine patients (20.4 per­cent) were 65 years of age or older, while 62 (43.6 percent) were between 40 and 65 years; 51 patients (36 percent) were younger than 40 years.

Disease exclusive to the upper lobes was found in 56 (39 percent) of the 142 patients. A further 63 patients (44 percent) had disease involving upper lobes and either middle, lingular, or lower lobes. Only 23 patients had either miliary disease or lesions located in lung fields other than the upper lobes. The segmen­tal localization of lesions in patients with upper lobe disease is shown in Table 1. Involvement of either the posterior or apical segments of the right upper lobe was at least twice as common as involvement of the anterior segment of that lobe. Apico-posterior disease of the left upper lobe was at least four times more likely to occur than disease affecting the anterior segment of that lobe. The right anterior segment was involved almost twice as often as the left anterior segment.

Table 1—Roentgenographic Distribution of Pulmonary Tuberculosis within the Upper Lobes in Adult Patients

Year

Upper Lobet

No. of Cases

Lesions Confined
to Upper Lobe Only

Right Upper Lobe

Left Upper Lobe

RAS

RPS

RApS

LAS

LAPS

1983

14

5

2

10

9

1

8

1984

32

12

11

24

21

4

17

1985

24

14

10

15

18

3

12

1986

19

12

1

9

9

1

12

1987

13

7

3

7

7

2

7

1988

17

6

4

7

6

6

11

n

119

56

31

72

70

17

67

Of the 56 patients with disease involving only the upper lobes of the lung, nine had disease predomi­nantly localized to the anterior segment of the upper lobe. Considered in the context of the entire group of 142 patients, predominant involvement of the upper lobe anterior segment occurred in nine (6.3 percent) of 142 patients. Of this group of nine patients, disease restricted to the anterior segment was noted in four (patients 1 through 4, Table 2). This result represented and incidence of 7 percent of patients with upper lobe involvement (four of 56) or 2.8 percent of all patients (four of 142). The infiltrates observed were either dense consolidations (two patients) or nodular masses (two patients, Fig 1). Minimal adjacent disease of one other upper lobe segment was present in a further five patients (patients 5 through 9; Table 2 and Fig 2). The incidence of both isolated and predominant anterior segment disease was 16 percent of patients with upper lobe involvement (nine of 56). Interestingly, the anterior segment of the left upper lobe was involved in two patients only, whereas all nine patients had involvement of the right anterior segment of the upper lobe.
generic cialis soft tabs

Figure 1. Chest roentgenogram of patient 1 demonstrating a nodular mass in the anterior segment of right upper lobe. Left, posteroanterior view: right, lateral view.

Where sufficient data were available, an attempt was made to distinguish between primary-onset and reactivation forms of tuberculosis in patients with anterior segment disease. In only three of our patients was information available regarding previous skin test status. Another three patients who had been healthy previously were known to have had recent exposure to a family member with active pulmonary disease. Five of the patients had either a history of distant past exposure or roentgenographic evidence suggesting old apical tuberculosis with or without calcified hilar adenopathy. Patients 1, 2, 5, 6, and 7 (Table 2) were believed to have case histories and roentgenographic findings compatible with prior exposure to tuberculo­sis. However, patients 3, 4, 8, and 9 in all likelihood had adult-onset primary tuberculosis.

Table 2—Clinical Features and Roentgenographic Localization of Anterior Segment Tuberculosis

Cultures

Patient No./

Underlying

Positive

Age, y/Sex

Diseases

for MTB

Disease Type

Roentgenographic
Features

1/56/M

Alcoholism,
diabetes

Sputum

Reactivation

RAS nodular mass
(Fig
1)

2/77/F

Diabetes

Lung

Reactivation

RAS nodular mass

3/28/M

IVDA

Sputum

Primary

Bilateral
anterior segment consolidation

4/77/M

COPD

Sputum

Primary

Bilateral
anterior segment nodular infiltrates

5Z35M

Alcoholism

Sputum

Reactivation

RAS and minimal
RPS infiltrates (Fig
2)

6/84/F

Rheumatoid
arthritis, receiving corticosteroids

Sputum

Reactivation

RAS and minimal
RApS infiltrates

7/72/M

Alcoholism,
adenocarcinoma of lung

Sputum

Reactivation

RAS and minimal
RPS infiltrates

8/34/M

None

Sputum

Primary

RAS and minimal
RPS infiltrates

9/27/F

None

Sputum

Primary

RAS and minimal
RPS infiltrates

Figure 2. Chest roentgenogram of patient 5 demonstrating consolidation of anterior segment of right upper lobe (left, posteroanterior view) and several nodular lesions in the right posterior segment (right, lateral view).

The incidence of associated conditions differed between patients with anterior segment disease and all other patients (Table 3). The incidence of alcohol abuse, advanced age, diabetes, concurrent malignant neoplasm, or steroid use was increased in patients who presented with anterior segment disease. On further analysis, however, only the incidence of dia­betes was significantly greater in the group with anterior segment disease. None of the group with anterior segment disease had features suggestive of human immunodeficiency virus (HlV)-related syn­dromes. Only one of these patients (patient 3) had a history of intravenous drug abuse. The HIV serologic test was negative in this instance. Of the group of 142 patients, seven were known to be intravenous drug abusers. Three of these had concomitant diagnoses of the acquired immunodeficiency syndrome (AIDS). It is likely that this represents underrecording of the association as HIV serologic tests were not performed routinely during the early years of the present study. cialis soft tabs

Table 3—Anterior Segment Upper Lobe Disease and Associated Conditions

Patient Category
(No.)

No.
(%),
with Indicated Condition

Age,
+ 65
yr

Alcoholism
Diabetes

Steroid Use

Neoplasia

Anterior segment
(9)
All other cases
(133)

4 (44) 25 (19)

3 (33) 16 (12)

2 (22)* 3 (2)

i (ID

3 (2)


1

(id

2
(2)