Satellite Nodules with Pericavitary Consolidation Presenting As ‘Black Hole in the Starry Sky Pattern’ in HRCT Thorax: A Strong Predictor of Active Pulmonary Tuberculosis!

Abstract

Pulmonary tuberculosis is the most common cause for cavitary lung disease in India. Radiological presentations in pulmonary tuberculosis are different and mainly depend on the immune status of hosts, durations of illness and underlying comorbidities. Consolidation, cavitation, pleural effusion, airways disease and lymphadenopathy are frequently reported in thoracic tuberculosis. In this case report, a 36-year male, presented with constitutional symptoms for 4 months duration with partial response to medical treatment received according to their knowledge and experience towards pneumonia, bronchial asthma and bronchitis. Radiological investigations documented inhomogeneous nodular infiltrates in the left upper zone which was underestimated due to presence of crepitations and wheeze. Recurrent, progressive and partially responding constitutional symptoms was the reason for referral to our center. We have further evaluated with HRCT thorax due to nodular opacities and persistent symptoms and documented black hole in the starry sky pattern’ which is first time described in medical literature. ‘Blackhole in starry sky pattern’ is described in the present case as a giant lung cavity mimicking black hole and a satellite nodule mimicking a starry sky pattern. Satellite nodules are defined as ill-defined to well demarcated nodular opacities with or without conglomeration around tuberculous consolidation or cavity. We have done induced sputum microbiological workup and documented acid-fast bacilli in sputum smear and MTB genome with rifampicin sensitivity in cartridge based nucleic acid amplification test. Treatment initiated with anti-tuberculosis (ATT) and recorded near complete radiological resolution, bacteriological cure after six months with good compliance. High index of suspicion is required while managing these cases with constitutional symptoms with Satellite nodules with pericavitary consolidation presenting as ‘black hole in the starry sky pattern’ in HRCT thorax to have successful treatment outcome.