Tuberculosis

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Tuberculosis

• Imaging Review
• John W. Renner, M.S., M.D.
• Clinical Professor of Radiology
• UCSD Medical Center
• Brendan Kidder, M.S. IV
• UCSD Medical School

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Imaging of Tuberculosis

• Primary Tuberculosis
• Previously considered a disease of childhood
• Now, 25-35 of all cases of adult cases
• Post-primary Tuberculosis
• Previously considered a disease of adolescence
  and adulthood
• Re-infection AND reactivation tuberculosis
• Progressive disease

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Imaging of Tuberculosis

• Primary Tuberculosis
• Chest radiograph
• Normal in up to 15 of patients
• Parenchymal disease
• Lymphadenopathy
• Miliary disease
• Pleural effusion

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Imaging of Tuberculosis

• Parenchymal Disease
• Dense, homogenous consolidation
• May infect any lobe, but more predominance in
  lower lobes, middle lobe and lingula
• Resembles bacterial pneumonia
• May resolve without sequelae, sometimes prolonged
• Radiographic scar (Ghon focus)
• Tuberculoma

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Imaging of Tuberculosis

• Lymphadenopathy
• More common in children
• Usually unilateral, right-sided
• Necrotic nodes
• May be sole radiographic finding
• Ranke complexGhon focus plus calcified hilar
  lymph nodes
• Prolonged resolution

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Imaging of Tuberculosis

• Miliary Disease
• Clinically significant in small percentage of
  patients
• Infants, elderly and immunocompromised
• Randomly distributed small 2-3 nodules
• Slow resolution with theraphy

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Imaging of Tuberculosis

• Pleural Effusion
• Up to ¼ of patients with primary tuberculosis
• May be sole manifestation of disease with onset
  months after initial exposure
• Unilateral, often complex
• Empyema, fistulization,bone erosion rare
• May leave residual pleural thickening and
  calcification

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Imaging of Tuberculosis

• Active vs. Inactive disease
• Old chest examinations
• Stable chest Roentgenogram for six months or more

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Imaging of Tuberculosis

• HIV and Tuberculosis
• HIV adversely affects macrophage function
• HIV destroys CD4 lymphocytes
• If CD4 count is gt 200 cells/ microliter, typical
  tuberculosis is seen
• If CD4 count is lt 200 cells/microliter, findings
  resemble primary tuberculosis
• Consolidation, lymphadenopathy, centrilobular
  nodules, tree-in-bud and pleural effusion

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Imaging of Tuberculosis

• MAC (Mycobacterium avium-intracellulare complex)
• Resembles post-primary MTBapical-posterior
  segments, consolidation, cavities, scar
  formation, small nodules (Males, COPD)
• Bronchiectasis, centrilobular nodules, RML and
  Lingular location, large nodules, patchy
  consolidation (Females, gt 60 y/o)
• Hypersensitivity Pneumonitis (hot tub
  lung),patchy GGO, poorly defined nodules

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