A CT scan of Mr. Tong’s chest at Tam Anh General Hospital revealed multiple cavitary lesions and nodular consolidations in both lungs. A "tree-in-bud" pattern was observed in the right lung and the upper lobe of the left lung.

Master of Science, Doctor Vo Thi Anh Nhat, from the Department of General Internal Medicine at Tam Anh General Hospital TP HCM, explained that this image describes inflamed small bronchioles filled with secretions or pus, creating a shape resembling tree branches with buds on the scan. This sign is common in patients with active pulmonary tuberculosis, indicating that bacteria have spread along the small airways in the lungs. Sputum test results confirmed the patient had advanced pulmonary tuberculosis.

CT scan showing multiple small nodules and hazy masses resembling "tree-in-bud" in the lungs (right image). Photo: Tam Anh General Hospital

Doctors also detected necrotizing pneumonia, a severe infectious complication that can damage lung parenchyma if not treated promptly.

Specialized tests showed an HbA1c index (average blood sugar over three months) of 11,9%, nearly double the normal level, leading doctors to diagnose type 2 diabetes. Capillary blood sugar exceeded 370 mg/dL, requiring doctors to use insulin for control.

Diabetes can exist silently for many years without causing noticeable symptoms. "When blood sugar is uncontrolled, the immune system weakens, creating favorable conditions for infections to develop, including pulmonary tuberculosis", Doctor Nhat explained.

In addition to diabetes, Mr. Tong also had a high viral load of hepatitis B virus. Test results also indicated mixed dyslipidemia, increasing the risk of cardiovascular disease and metabolic complications.

The patient had smoked for many years, frequently consumed alcohol, and preferred fatty foods. According to Doctor Nhat, these factors can negatively impact respiratory, liver, and metabolic health if prolonged.

The patient received anti-tuberculosis medication according to the standard regimen, treatment for hepatitis B, pneumonia control with antibiotics, and insulin along with blood sugar-regulating medications.

After nearly two weeks of treatment, the patient's respiratory condition significantly improved. He experienced less coughing, no fever, no shortness of breath, and improved appetite. The pneumonia was controlled, and blood sugar gradually stabilized before discharge, with outpatient pulmonary tuberculosis treatment continuing for 6-12 months.

Doctor Nhat explains Mr. Tong's health condition in detail. Photo: Tam Anh General Hospital

Doctor Nhat advised that individuals experiencing symptoms such as a cough lasting over two weeks, unexplained weight loss, night sweats, fatigue, excessive thirst, or frequent urination should seek early medical attention. Adults, especially those who smoke, frequently consume alcohol, or have an unhealthy lifestyle, should undergo regular health check-ups at least once a year to detect respiratory diseases, diabetes, dyslipidemia, and liver disease early.

Nhat Thanh

*The patient's name has been changed