TB or not TB: The Half Full Glass

Abstract

To the Editor:The editorial by Kovnat, “Different conclusions from Similar Data: The Half Empty Glass” (Chest 1986; 89:1), emphasizes the similarities between the data collected by he and his colleagues in the mid-1970s and our data collected in the early 1980s. He points out that he and his colleagues emphasized “unusual” presentations, while we emphasized “usual” presentations.We think it was quite appropriate to place emphasis on “unusual” presentations of pulmonary tuberculosis in the mid-1970s. At that time, the shift from sanitarium to outpatient and general hospital management of tuberculosis had just been accomplished. There was a need to point out that there are quite a number of zebras in the world. Kovnat and his colleagues, and others, have done their job well. House officers and younger physicians are attuned to the fact that pulmonary tuberculosis may present with atypical roentgenographic findings. So attuned, in fact, that they seem to think atypical roentgenographic presentations of TB are the rule.Our purpose was to point out the fact that “pulmonary tuberculosis still presents with upper lung field cavitary infiltrates in the majority of instances”; that if it looks like “classical” TB on the chest roentgenogram, it probably is TB (when you see a horse, don't perceive a zebra; a horse is, indeed, usually a horse).The glass may be half full or half empty; both perceptions deserve emphasis. To the Editor: The editorial by Kovnat, “Different conclusions from Similar Data: The Half Empty Glass” (Chest 1986; 89:1), emphasizes the similarities between the data collected by he and his colleagues in the mid-1970s and our data collected in the early 1980s. He points out that he and his colleagues emphasized “unusual” presentations, while we emphasized “usual” presentations. We think it was quite appropriate to place emphasis on “unusual” presentations of pulmonary tuberculosis in the mid-1970s. At that time, the shift from sanitarium to outpatient and general hospital management of tuberculosis had just been accomplished. There was a need to point out that there are quite a number of zebras in the world. Kovnat and his colleagues, and others, have done their job well. House officers and younger physicians are attuned to the fact that pulmonary tuberculosis may present with atypical roentgenographic findings. So attuned, in fact, that they seem to think atypical roentgenographic presentations of TB are the rule. Our purpose was to point out the fact that “pulmonary tuberculosis still presents with upper lung field cavitary infiltrates in the majority of instances”; that if it looks like “classical” TB on the chest roentgenogram, it probably is TB (when you see a horse, don't perceive a zebra; a horse is, indeed, usually a horse). The glass may be half full or half empty; both perceptions deserve emphasis.