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TB, Lung Abscess, and Cystic Fibrosis

TB, Lung Abscess, and Cystic Fibrosis. TB. Radiographic findings in primary TB are Nonspecific Tends to like the lower lung zones Cavitation is not as common in primary TB as in reactivation TB However lymphadenopathy is a common finding in primary TB and uncommon in reactivation TB.

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TB, Lung Abscess, and Cystic Fibrosis

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  1. TB, Lung Abscess, and Cystic Fibrosis

  2. TB • Radiographic findings in primary TB are Nonspecific • Tends to like the lower lung zones • Cavitation is not as common in primary TB as in reactivation TB • However lymphadenopathy is a common finding in primary TB and uncommon in reactivation TB

  3. TB • Patchy left lower lobe opacity • Looks like pneumonia

  4. TB • Right upper and lower lobe consolidation • Right pleural effusion

  5. TB • Cavitary right upper lobe lesion • Right paratracheal lymphadenopathy • Right middle lobe infiltrate • Notice the ipsilateral lymphadenopathy

  6. TB • Thick walled cavity with satellite nodules • Smooth inner wall

  7. TB • Focal right middle lobe infiltrate • Nodular like infiltrate • Endobronchial spread of TB • Adjacent areas of lung are infected by bronchial secretions

  8. TB • Radiographic findings usually present 2 years after initial infection • Infiltrates usually like the apical and posterior segments of upper lobes and superior segment of lower lobes

  9. TB • CT scan through the upper chest shows a thick walled cavity with an air fluid level and surrounding infiltrate • Cavities result from caseous necrosis

  10. TB • Complications of TB cavities • Mycetoma “fungus ball” • Rasmussen Aneurysm which is weakening of bronchial artery adjacent to a cavitary lesion

  11. Rasmussen Aneurysm

  12. TB • Bilateral lung nodules resulting from endobronchial spread of TB • Right upper lobe cavity

  13. Miliary TB • Right paratracheal lymphadenopathy • Bilateral tiny uniform nodules • Diffuse pattern of nodules is due to hematogenous spread

  14. Miliary TB

  15. TB Key Points • Imaging findings of primary TB are nonspecific • Primary TB differentiated from bacterial pneumonia by the presence of lymphadenopathy • Reactivation TB recognized by fibrocavitary disease and a history of prior exposure

  16. TB Key Points • Inactive disease cannot be established without prior films • Primary TB tends to affect the lower lungzones while reactivation TB tends to affect the upper lung zones

  17. Pneumococcal PNA • Complications • Lung necrosis • Abscess formation • Often need clinical history to distinguish from TB

  18. Lung Abscess • Air fluid level within a large cavity • Can communicate with the pleura resulting in an empyema

  19. Lung Abscess

  20. Lung Abscess • 54 year old male with cough and foul smelling sputum • Cavity within the superior segment of the left lower lobe • Common site for aspiration

  21. Lung Abscess • Irregular cavity • Typically more posterior • Often has an air/fluid level within it • Often has surrounding infiltrate

  22. Lung Abscess • Cavity with air fluid level and foul smelling sputum • Anaerobic organisms often the cause of abscesses from aspiration

  23. Lung Abscess Key Points • Typical radiographic appearance is an irregular cavity with an air fluid level • Lung abscesses from aspiration often occur in the posterior segments of upper lobes or superior segments of lower lobes • The wall thickness of lung abscesses progresses from thick to thin and irregular to well circumscribed

  24. Cystic Fibrosis • Abnormal sodium/chloride transport in exocrine tissues • Results in thick viscous mucus • Obstructs airways resulting in repeat infections and colonization • Airways dilate and cysts form from air trapping • Scarring from the repeated infections

  25. Cystic Fibrosis • Hyperinflation • Upper lobe bronchiectasis • Tram tracking

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