Abstract:

Objective To explore the imaging characteristics and clinical diagnostic value of pulmonary tuberculosis with the “crawling sign” as the main radiological feature. Methods Clinical and imaging data of a patient treated in the Respiratory Department of Xichong County People's Hospital were retrospectively analyzed. Results A 55-year-old man with type 2 diabetes mellitus presented with a pulmonary nodule found on routine examination 10 months earlier. During an 8-month follow-up, chest CT showed disease progression from a solitary nodule in the apicoposterior segment of the left upper lobe to a tubular lesion extending along the bronchovascular bundles toward the hilum, which was known as the crawling sign. Pathologic biopsy revealed granulomatous inflammation with necrosis. Tuberculosis (TB)-DNA testing confirmed a diagnosis of secondary pulmonary tuberculosis. Conclusion The crawling sign may serve as a suggestive imaging feature of pulmonary tuberculosis, particularly secondary pulmonary tuberculosis. It helps improve the accuracy of early diagnosis.

Key words: tuberculosis, pulmonary, crawling sign, imaging, granuloma