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Tuberculosis (TB) remains the "great pretender." We report the case of a 10-year-old female, who presented with a mass in the left chest that was suspected initially to be a tumor. This was later confirmed to be tuberculous in nature, with dissemination to the liver. A large granuloma eventually replaced the left lung, leaving her with "tuberculous destroyed lung" (TDL), an extremely rare, life-threatening sequela of the disease. We review the pathophysiology, radiologic findings, and management options, which includes pneumonectomy, for this seldom seen but preventable condition., (Copyright © 2011 Wiley Periodicals, Inc.)

Wheeze as an indicator of airway obstruction during bronchoprovocation lacks sensitivity. We therefore studied whether induced airway narrowing is revealed by changes in normal (vesicular) lung sounds. Fifteen subjects with asthma and nine healthy controls, aged 8-16 years, performed a standardized methacholine challenge. Respiratory sounds were recorded with eight contact sensors, placed posteriorly over the right and left superior and basal lower lobes, and anteriorly over both upper lobes, the right middle lobe, and the trachea. Average spectra of normal inspiratory and expiratory sounds, excluding wheeze, were characterized in 12 asthmatics and 9 controls at flows of 1 +/- 0.2 L/sec. Airway narrowing was accompanied by significant changes in lung sounds, but not in tracheal sounds. Lung sounds showed a decrease in power at low frequencies during inspiration and an increase in power at high frequencies during expiration. These changes already occurred at a decrease in forced expiratory volume in 1 sec of less than 10% from baseline and were fully reversed after inhalation of salbutamol. Thus, lung sounds were sensitive to changes in airway caliber, but were not specific indicators of bronchial hyperresponsiveness.