Happy Chinese New Year of the Fire Monkey!

I am privileged to have a second contribution by another fellow (non-infectious diseases) colleague. Although I suppose in some ways a respiratory specialist is close…

A middle-aged non-smoking local woman had cough associated with whitish sputum for 2 months. No significant contact or travel history. No other co-morbidities, no fever, and no weight loss. Her chest X-ray and a slice of the subsequent CT thorax are shown below.

Question: What is the most likely diagnosis and how can it be confirmed?

[Updated 20th February 2016]

The changes on the chest X-ray are better appreciated on the CT scan. There are nodular infiltrates with radiological “tree-in-bud” features at the upper portion of the right lower lobe of the lung, suggestive of pulmonary tuberculosis. Diagnosis can be confirmed by sputum collection (2 separate samples) for Ziehl-Nielsen staining for acid-fast bacilli, TB PCR and mycobacterial cultures.