Tuberculosis- what is essential to know?

1. Tuberculosis- what is essential to know? JK Amorosa

2. LLL, L pl eff, endobronchial spread 23 m June October

3. 23 m

4. 23 m

5. TB - Endobronchial spread granuloma Müller, N.L et al. Diseases of the Lung Radiologic and Pathologic Correlations 2003

6. 22 m fever

8. RUL atelectasis, endobronchial TB diff: squamous cell ca

9. 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

10. 19 f TB mediastinaladenopathy

11. Young patient with fever and chest pain TB mediastinal adenopathy Harisinghani,MG Radiographics ’00

12. 51 yo immigrant with fever TB mediastinal abscess

13. Intrathoracic- Lymphadenopathy • 96% of children and 43% of adults • Unilateral and right sided, involving the hilum and right paratracheal -bilateral in about one-third of cases • Low-attenuation center secondary to necrosis CT – active • Calcified hilar nodes and a Ghon focus (Ranke complex) - previous tuberculosis

14. RUL cavity & atelectasis 12 yo with fever and cough

15. RUL consolidation, minimal atelectasis and R hilaradenopathy • 29 f pregnant fatigue

16. 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

17. 29 m

18. Miliary pattern

19. 32 m • R hilaradenopathy • Miliary pattern • Focal RUL opacities

20. Pattern? Miliary

21. 45 yo f asymptomatic SARCOIDOSIS, ddx:lymphoma

23. Calcified bilat nodules Ddx: chicken pox, histo, TB

24. 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

25. Diff Dx: TB pleuritis, Malignancy Hemothorax Chylothorax 37 yo m with cough and chest pain

27. 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

28. Tuberculoma RA TB pericarditis Harisinghani

29. 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

30. 40 yo m with cough RUL cavity; Ddx: TB, abscess, CA

31. RUL cavity, atelectasis Ddx: TB, abscess, CA 55 f with fever, cough & wt loss

32. LUL cavity, Ddx: TB, abscess, CA 66 m cough

33. 62 m c cough LUL cavities and bilateral endobronchial spread Ddx: TB, CA

34. 69 m with worsening COPD LUL cavitary lung opacity; TB Ddx: CA, abscess

35. Morbidly obese f in her 50’s with persistent post-op fever R apical cavity, TB; Ddx: CA

36. Müller, N.L et al. Diseases of the Lung Radiologic and Pathologic Correlations 2003

37. 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

39. Fibrosis, cavity and … fungus ball DX: SARCOIDOSIS STAGE IV

40. Single Cavity • TB • Histo • CA • Abscess

41. 69 yo pre-op Calcified granulomatous complex

42. Asymptomatic Calcified granulomas

43. Pulmonary nodule, metabolically active dx: tuberculoma Harlsinghani

45. TB bronchiectasis c atelectasis RUL, LLL pneumonia

46. TB bronchiectasis c atelectasis

47. 62 yo f chronic cough Total left lung atelectasis with bronchiectasis

48. 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

49. 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 PulmonaryTuberculosis

50. 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 “