A 12-year-old child has been experiencing a persistent dry cough and fever for four weeks. A chest X-ray reveals hilar lymphadenopathy on the right side and consolidation of the right middle lobe. Which of the following conditions is the most likely diagnosis in this case?
A. Pneumococcal pneumonia
B. Benign tumor of the right bronchus
C. Primary pulmonary tuberculosis
D. Interstitial lung disease
E. Hodgkin’s disease
Answer:
- Primary pulmonary tuberculosis
Explanation:
In a 12-year-old child with a four-week history of dry cough, fever, and specific chest X-ray findings of hilar lymphadenopathy on the right side and consolidation of the right middle lobe, the most probable diagnosis is primary pulmonary tuberculosis.
Here’s the rationale:
- Hilar Lymphadenopathy: Enlarged hilar lymph nodes, as seen in the X-ray, are characteristic of primary tuberculosis, often referred to as the “Ghon complex.” This signifies an initial Mycobacterium tuberculosis infection.
- Right Middle Lobe Consolidation: The consolidation in the right middle lobe can result from the spread of tuberculosis infection. The right middle lobe is a common site for tuberculosis involvement.
- Fever and Persistent Cough: These are typical symptoms of tuberculosis.
Now, let’s briefly address the other options:
- Pneumococcal pneumonia: While pneumonia can lead to fever and cough, the described X-ray findings (hilar lymphadenopathy and right middle lobe consolidation) are not typical of pneumococcal pneumonia.
- Benign tumor of the right bronchus: Benign tumors are rare in children and are unlikely to produce the specific radiological results mentioned.
- Interstitial lung disease: Interstitial lung disease generally doesn’t present with hilar lymphadenopathy or right middle lobe consolidation.
- Hodgkin’s disease: Although Hodgkin’s disease can involve lymph nodes, it typically comes with other constitutional symptoms such as night sweats, weight loss, and widespread lymphadenopathy. The chest X-ray findings here are more indicative of tuberculosis.
Hence, considering the clinical presentation and radiological findings, the most probable diagnosis is primary pulmonary tuberculosis. Further diagnostic tests like sputum examination for acid-fast bacilli and tuberculin skin testing would be needed to confirm the diagnosis.