Primary TB versus viral bronchopneumonia

14 years old female with fever and dyspnea.

The left upper lobe shows ill-defined opacity probably consolidative. Another upper lobar patchy opacities are seen. The left hilum is prominent suggesting lymphadenopathy. Another less conspicuous similar opacities are seen at right lower lobe. Ghon's focus of primary TB is suggested. Viral bronchopneumonia is also possibility but less like in presence of fever and hilar adenopathy.

Primary TB occurring usually at well aerated areas as middle and lower lobes and anterior segments of upper lobes. Reactivation TB occurs in apical segments of lower lobes and apico-posterior segments of upper lobes.
Extremely rare to find pleural effusion in presence of parenchymal disease; para-pneumonic effusions of viral and bacterial etiologies is common.

BE CAUTIOUS: bilateral lung parenchymal ground glass opacities or rapidly progressive basal consolidation is suggestive of SWINE FLU!!!