RADIOGRAPHIC MANIFESTATIONS OF PULMONARY TUBERCULOSIS

DR. DEVKANT LAKHERA

CAUSE AND TRANSMISSION OF TUBERCULOSIS AND PROGRESSION OF LATENT INFECTION

Radiological patterns may be considered under the following groups:

1. Typical radiological patterns of primary TB.

2. Post primary TB or Reactivation TB.

3. Patterns encountered in both primary and/or postprimary TB.

4. Complications and sequelae of TB.

PRIMARY TB

• The most common abnormality in children is lymph node enlargement, which is seen in 90–95% of cases.

• 10-year-old child with tuberculosis, shows widening of the right paratracheal stripe

CECT show tuberculous nodes that show central areas of low attenuation suggestive of caseous necrosis and peripheral rim enhancement

GHON FOCUS

• Ghon focus may be visualized on the chest radiograph as an airspace opacity

GHON LESION/FOCUS

• Small tan-yellow subpleural granuloma in the mid-lung field on the right.

• Over time, the granulomas decrease in size and can calcify, leaving a focal calcified spot on a chest radiograph that suggests remote granulomatous disease.

GHON COMPLEX

• typical of primary tuberculosis in a child

• Parenchymal involvement is more in adults.

RANKE COMPLEX

• The combination of calcific lesions of the lung and lymph node is referred to as the “Ranke complex”

• Airspace consolidation is usually unilateral, is evident radiographically in approximately 70% of children with primary TB

• obtained at level of right middle lobar bronchus

PLEURAL EFFUSION IN TB

Pleural effusion is usually unilateral and due to subpleural infection.

Pleural effusions are more common in adults with primary tuberculosis (40%).

shows a right upper lobe airspace opacity adjacent to the trachea. In addition, there iselevation of the minor fissure (arrows),

(ATELECTASIS) VOLUME LOSS

POST-PRIMARY TUBERCULOSIS

• focal or patchy heterogeneous consolidation involving the apicoposterior segments of the upper lobes and the superior segments of the lower lobes

• lateral view of the same patient, the typical location of the apicoposterior segment

•Predilection for upper lobes

•Lack of lymphadenopathy

•Propensity for cavitation

Post-primary tuberculosis distinguishin

g features

POST-PRIMARY TUBERCULOSIS/REACTIVATION TUBERCULOSIS

• The predilection for the upper lobes is thought to be due to decreased lymph flow in the upper regions of the lung.

• An alternative explanation is the presence of higher oxygen tension in that region.

CAVITATION

• Xray showing cavitatory consolidation in right upper lung zone and multiple ill-defined nodules in both lungs

Cavitation and tree in bud sign is indicative of an active disease process and usually heals as a linear or fibrotic lesion.

MILIARY TUBERCULOSIS

Miliary TB refers to widespread dissemination of TB by hematogenous spread.

Seen more frequently in reactivation TBSeen in pts withLocation

The characteristic radiographic and high resolution CT findings consist of innumerable, 1- to 3-mm diameter nodules randomly distributed throughout both lungs

chest radiograph shows innumerable millet-sized nodular opacities and ground-glass opacities in both lungs

Sequelae of healed primary TB, but may be seen in 3–6 percent of cases of postprimary tuberculosis as the main or only abnormality

TUBERCULOMA

HEALED TB

calcified nodule consistent with a calcified granuloma. In addition, there isbilateral apical pleural thickening

COMPLICATIONS AND SEQUELAE

ASPERGILLOMA

tuberculous cavity can be colonized by Aspergillus speciesand present as an “aspergilloma”

spherical nodule or a massseparated by a crescent-shaped area of decreased opacity or air from the adjacent cavity wall

BRONCHIECTASIS

Bronchiectasis is seen in 30%–60% of patients with active postprimary tuberculosis and in 71%–86% of patients with inactive disease at high-resolution CT

HRCT shows traction bronchiectasis inthe right upper lobe

This case demonstratesa left pleural effusion with air-fluid levels consistent with a hydropneumothorax caused by the bronchopleural fistula. Diagnosis of hydropneumothorax is based on the presence of a pleural effusion accompanied by an air-fluid level within the pleural space.

TUBERCULOUS EMPYEMA

BRONCHOPLEURAL FISTULA

Empyema may also communicatewith the bronchial tree by bronchopleural fistula and can showan air fluid level

VASCULAR COMPLICATIONS

Bronchial arteriesmay be enlarged in bronchiectasis associated with TB

RASMUSSEN ANEURYSM

Rasmussen aneurysm is a pseudoaneurysm that results from weakening of the pulmonary artery wall by adjacent cavitatory TB

CECT obtained shows cavitatory consolidationwith air-crescent sign in left upper lobe.

Pneumothorax occurs in approximately 5 percent of patientswith postprimary TB, usually in severe cavitatory disease.

PNEUMOTHORAX

PLEURAL EMPYEMA

Bacilli can enter the pleural space from a juxtapleuralcaseating granuloma, orvia hematogenous dissemination

TRACHEOBRONCHIAL STENOSIS

BRONCHOGENIC CARCINOMA

• Tuberculosis may predispose to the development of bronchogenic carcinoma by local mechanisms (scar cancer)

• Carcinoma may lead to reactivation of TB, both by eroding into an encapsulated focus and by affecting the patient’s immunity.

BRONCHOLITH

PERICARDITIS

Tuberculous pericarditis reported to complicate 1 percentof cases of TB is commonly caused by extranodal extensionof tuberculous adenitis into the pericardium

• As the CD4 lymphocyte count declines, the radiographic findings look more like those seen in primary disease.

• The radiographic opacities may be in the lower lung zones and multilobar in nature.

• Lymphadenopathy is more common.

TUBERCULOSIS AND HIV

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BRONCHOPLEURAL FISTULA

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TUBERCULOSIS IN INDIA

• India is responsible for 1/3rd of the global cases of tuberculosis

• 1.8 million new cases of tuberculosis are reported every year

PULMONARY TUBERCULOSIS

• 95% - MYCOBACTERIUM TUBERCULOSIS

• 5% - ATYPICAL MYCOBATERIUM

LYMPH NODES ENLARGEMENT

GANGLIOPULMONARY T.B

• Very specific to primary t.b mediastinal and/or hilar adenopathies and less conspicuous parenchymal abnormalities.

• preferential occurrence in children, it has been designated as “childhood”-type TB;