In tuberculosis, chest X-ray findings may include which of the following?

• A. Pleural effusion
• B. Cavitation in upper lobes
• C. Hilar lymphadenopathy
• D. Normal chest X-ray

Answer: (C)

The main concept here is that tuberculosis often involves the lymphatic system in the lungs, especially in primary infection. When TB first infects, the bacteria travel to and inflame the hilar and mediastinal lymph nodes. This causes enlargement of the hilar lymph nodes, which shows up on chest X-ray as prominent or widened hilar markings. This finding is a classic feature of primary TB, and it’s why hilar lymphadenopathy is a key radiographic clue.

In adults with reactivation TB, you’d more commonly see cavitation in the upper lobes, reflecting different disease behavior in a later stage. Pleural effusion can occur with TB but is not as characteristic as hilar lymph node enlargement, and a normal chest X-ray doesn’t exclude TB, especially early in the disease or in atypical presentations. So, recognizing hilar lymphadenopathy helps identify TB in the right clinical context, particularly in primary disease.