Transcript Tuberculosis- what is essential to know?

Tuberculosis- what is
essential to know?
JK Amorosa
23 m

June
LLL, L pl eff,
endobronchial spread
October
23 m
23 m
TB - Endobronchial spread
granuloma
Müller, N.L et al. Diseases of the Lung Radiologic and Pathologic Correlations 2003
22 m fever
RUL atelectasis, endobronchial TB
diff: squamous cell ca
Airway TB



Bronchial stenosis - lobar collapse or
hyperinflation, obstructive pneumonia, mucoid
impaction
Long segment narrowing with irregular wall
thickening, luminal obstruction, and extrinsic
compression
Tree-in-bud opacities and traction
bronchiectasis - upper lobes
TB mediastinal adenopathy

19 f
Young patient with fever and
chest pain
TB mediastinal
adenopathy
Harisinghani,MG
Radiographics ’00
51 yo immigrant with fever
TB mediastinal abscess
Intrathoracic- Lymphadenopathy




96% of children and 43% of adults
Unilateral and right sided, involving the hilum
and right paratracheal -bilateral in about onethird of cases
Low-attenuation center secondary to necrosis
CT – active
Calcified hilar nodes and a Ghon focus (Ranke
complex) - previous tuberculosis
12 yo with fever and
cough
RUL cavity & atelectasis
RUL consolidation, minimal atelectasis
and R hilar adenopathy

29 f pregnant fatigue
TB – lung parenchyma


Dense, homogeneous parenchymal
consolidation in any lobe, predominance in the
lower and middle lobes - especially in adults
Looks like bacterial pneumonia except for
lymphadenopathy and the lack of response
to conventional antibiotics
29 m
Miliary pattern
32 m



R hilar adenopathy
Miliary pattern
Focal RUL opacities
Pattern?
Miliary
45 yo f asymptomatic
SARCOIDOSIS,
ddx:lymphoma
Calcified bilat nodules Ddx:
chicken pox, histo, TB
TB Lung parenchyma Miliary








1% to 7% of patients
elderly, infants, immunocompromised
manifestation within 6 months of initial exposure
Chest X-ray normal or hyperinflated
evenly distributed diffuse small 2–3-mm nodules, with a slight
lower lobe predominance - 85% of cases
CT is more sensitive than Chest X-ray
The nodules usually resolve - 2–6 months with treatment,
without scarring or calcification,
rare: coalescence c focal or diffuse consolidation
37 yo m with cough and
chest pain
Diff Dx: TB pleuritis,
Malignancy
Hemothorax
Chylothorax
Intrathoracic - Pleural Effusion








one-fourth of patients with primary tuberculosis
sole manifestation of tuberculosis, 3–7 months after
initial exposure
very uncommon in infants
Unilateral
empyema , fistulae, bone erosion rare
Residual pleural thickening /calcification
Ultrasonography (US) often demonstrates a complex
septated effusion
Sequalae: pleural thickening, calcification (calcified
fibrothorax

Tuberculoma RA
Harisinghani

TB pericarditis
Cardiac TB






0.5% of cases of extrapulmonary tuberculosis
Pericardial
immunocompromised patients
Myocardial involvement – rare, asymptomatic
Thickened, irregular pericardium with associated
mediastinal lymphadenopathy
IVC distention
40 yo m with cough
RUL cavity; Ddx: TB, abscess, CA
55 f with fever, cough
& wt loss
RUL cavity, atelectasis Ddx: TB, abscess, CA
66 m cough
LUL cavity, Ddx: TB, abscess, CA
62 m c cough
LUL cavities and bilateral endobronchial spread
Ddx: TB, CA
69 m with
worsening COPD
LUL cavitary lung opacity; TB Ddx:
CA, abscess
Morbidly obese f in her 50’s with
persistent post-op fever
R apical cavity, TB; Ddx: CA
Müller, N.L et al. Diseases of the Lung Radiologic and Pathologic Correlations 2003
Parenchymal manifestation-cavity




50% of patients
thick, irregular walls, which become smooth and
thin with successful treatment
multiple, occur within areas of consolidation
Resolution : emphysematous change or scarring
air-fluid levels: uncommon
Fibrosis, cavity and … fungus
ball
DX: SARCOIDOSIS STAGE IV
Single Cavity




TB
Histo
CA
Abscess
69 yo pre-op
Calcified granulomatous
complex
Asymptomatic
Calcified granulomas
Pulmonary nodule, metabolically active
dx: tuberculoma
Harlsinghani
TB bronchiectasis c atelectasis RUL, LLL pneumonia
TB bronchiectasis c atelectasis
62 yo f chronic cough
Total left lung atelectasis with
bronchiectasis
Tuberculosis






Resurgence in nonendemic populations due to
1.increased migration 2. HIV
Respiratory, cardiac, CNS, musculoskeletal, GI,
GU systems
History of infection or exposure to TB ca 50%
Tuberculin skin test does not in exclude
infection
Mimics other diseases
Biopsy or culture specimens are required to
make the definitive diagnosis
Pulmonary Tuberculosis





Primary
Childhood and
30% in adults because of
lack of unexposed adult
populations
Lymphadenopathy
Mid and lower lungs
Self-limiting









Postprimary
Adults and adolescents
Reinfection with/reactivation
Progressive
Cavitation
Upper>Lower lungs
Hematogenous and
endobronchial spread
Airway and pleural inv
Heals with fibrosis and
calcification
Leung


‘In 1993, the World Health Organization
declared TB to be a global emergency
At current control levels, it is estimated that
between 1997 and 2020, nearly 1 billion people
will become newly infected and 70 million
people will die from the disease “
Increase, esp multidrug-resistant
(MDR) TB



Africa
Asia
Europe
TB in Immunocompromised
patients




Higher prevalence
More MDR
Higher prevalence of extrapulmonary
Normal chest radiographic findings
TB Differential Dx “the
mimicker”









Primary:
Focal opacity: pneumonia, histo
Adenopathy: lymphoma, sarcoid, histo, mets
Pleural eff: malignancy, hemothorax, histo
Reactivation:
Cavity: lung ca, abscess
Healed (fibrotic):
radiation fibrosis
REFERENCES
Tuberculosis: A Radiologic Review
Joshua Burrill, Radiographics 2007; 27: 1255-73
 Tuberculosis from Head to Toe1 (RSNA Link)
 Mukesh G. Harisinghani, MD , Theresa C. McLoud,
MD, Jo-Anne O. Shepard, MD, Jane P. Ko, MD, ‘00
 Radiology. 1999;210:307-322.)
State of the Art
 Pulmonary Tuberculosis: The Essentials Ann N.
Leung, MD1
