Generalizations in medicine are dangerous, particularly with regard to lower lobe tuberculosis, because of its comparative infrequency.
Experience has taught us that chronic lesions in the upper lobe should be considered tuberculous until proved otherwise. Lesions in the lower lobe, on the contrary, should be considered nontuberculous until proved otherwise (Fishberg1).
It is our opinion that one should not be too ready to dismiss a diagnosis of pulmonary tuberculosis because of the location of the lesion in the lower lobe.
It is easy to understand why the internist and the phthisiologist make diligent search for confirmatory evidence of tuberculosis in upper lobe lesions, while, on the other hand, they favor a diagnosis such as unresolved pneumonia, chronic pneumonitis, bronchiectasis, abscess, syphilis and tumor when the lower lobe is affected. Tuberculosis becomes a remote possibility and is invariably easily dismissed by roentgen examination and one or more negative sputums.
HAMILTON CE, FREDD H. LOWER LOBE TUBERCULOSIS: A REVIEW. JAMA. 1935;105(6):427–430. doi:10.1001/jama.1935.02760320029009
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