Ursula was not evaluated again with TST and her mother stopped Ursula's INH after 3 months.
Approximately 6 weeks after cessation of the INH, Ursula developed respiratory symptoms and this radiograph was obtained:
Ursula's radiograph now shows a large right paratracheal lymph node (arrow) and right lung infiltrate consistent with active TB. Note that the trachea is now in the midline or even slightly to the left, suggesting pressure from the right sided paratracheal lymph node. In further history, not all the adults in Ursula's household have been fully evaluated for active TB and her grandfather has been coughing chronically.
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