Incidentally Detected Radiologically Suggestive Tuberculosis in Traumatic Soldiers: Uncovering the Hidden Burden of Tuberculosis in Somalia - A Retrospective Case Series and Literature Review

Background: Tuberculosis (TB) remains a major public health challenge in Somalia, with substantial underdiagnosis. In conflict-affected settings, trauma-related chest computed tomography (CT) is frequently performed, offering an opportunity for incidental detection of pulmonary TB. Objective: To describe radiological findings suggestive of pulmonary tuberculosis incidentally detected on trauma chest CT among injured soldiers in Somalia and to contextualize these findings within the national TB burden. Methods: A retrospective case series was conducted at a tertiary referral hospital in Somalia. Trauma chest CT scans performed on 1 March 2025 following a single blast incident were reviewed. Cases demonstrating CT features suggestive of active or post-primary pulmonary tuberculosis were identified. TB was not clinically suspected at presentation. Results: Three young adult male soldiers (aged 20-26 years) were incidentally found to have CT features suggestive of pulmonary tuberculosis, including upper-lobe consolidation with calcified nodules, thick-walled cavitary lesions, nodular ground-glass opacities, and pleural involvement. All findings were unrelated to acute traumatic injuries. Following stabilization, all cases were referred to the National Tuberculosis Program (NTP) for further evaluation. Conclusion: Trauma chest CT can reveal radiological patterns suggestive of pulmonary tuberculosis in high-burden settings such as Somalia. Radiologists play a critical role in opportunistic TB detection, particularly in emergency and trauma care, with important implications for infection control and public health surveillance.