docChest Radiography Pulmonary TB
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Chest Radiography Pulmonary TB
Chest Radiography Interpretation: Pulmonary TB Lisa Chen , M.D. Assistant Clinical Professor Pulmonary and Critical Care Division Department of Medicine San Francisco General Hospital Michael Gotway, MD Associate Clinical Professor, Radiology University of California, San Francisco Primary Primary TB: TB: Lung Lung Parenchyma Parenchyma •• Distribution: Distribution: Slight Slight upper upper lobe lobe predominance predominance but but any any lobe lobe can can be be involved involved •• Air-space Air-space consolidation consolidation •• Cavitation Cavitation is is uncommon uncommon (<10%) (<10%) •• Miliary Miliary pattern pattern 1° TB: Lobar Consolidation 1° TB: Lobar Consolidation 1° TB: Lobar Consolidation 1° TB: Miliary TB Primary Primary TB: TB: Hila Hila & & Mediastium Mediastium •• Adenopathy Adenopathy is is common, common, particularly particularly in in children children and and HIV HIV infected infected •• Predilection Predilection for for the the right right side side 1° TB: Adenitis 1° TB: Adenitis 1° TB: Adenitis Primary Primary Tuberculosis: Tuberculosis: Pleura Pleura •• Effusions Effusions common common in in adults adults •• Less Less common common in in children children •• May May be be only only finding finding in in primary primary disease disease 1° TB: Pleural Effusion Post -primary Tuberculosis Post-primary Tuberculosis Lung Lung Parenchyma Parenchyma •• Distribution Distribution apical/posterior apical/posterior segments segments of of upper upper lobes lobes superior superior segments segments of of lower lower lobes lobes right right side side more more common common isolated isolated anterior anterior segment segment involvement involvement is is unusual unusual (think (think M. M. avium avium complex) complex) Post-primary TB Post -primary Tuberculosis Post-primary Tuberculosis Lung Lung Parenchyma Parenchyma •• Patterns Patterns of of disease disease air air space space consolidation consolidation cavitation cavitation,, cavitary cavitary nodule nodule endobronchial endobronchial spread spread miliary miliary bronchostenosis bronchostenosis tuberculoma tuberculoma Post-primary TB: Consolidation Post – 1° TB: RX Post-primary TB: Cavitation Post-primary TB: Cavitary Nodule Post – 1° TB: RX Post 1° TB: Endobronchial Spread of Infection Post-primary TB: Miliary Post-primary TB: Bronchostenosis Post-primary TB: Bronchostenosis Post-primary TB: Tuberculoma Post-primary TB: Tuberculoma Post -primary TB: Post-primary TB: Pleura Pleura •• Pleural Pleural effusions effusions may may occur occur in in post-primary post-primary disease disease •• Empyema Empyema is is more more likely likely in in post post -primary primary disease disease •• Air Air // fluid fluid level level is is evidence evidence of of aa bronchopleural bronchopleural fistula fistula Post-primary TB Post-primary TB: Broncho-pleural fistula Chest Chest Radiograph: Radiograph: TB TB and and HIV HIV •• Chest Chest radiograph radiograph often often shows shows primary primary disease disease pattern pattern •• Adenopathy Adenopathy is is common common and and highly highly predictive predictive of of tuberculosis tuberculosis •• Radiograph Radiograph may may be be normal normal in in up up to to 10% 10% of of cases cases HIV & TB: Adenitis HIV & TB: Adenitis The The Chest Chest Radiograph: Radiograph: Healed Healed Tuberculosis Tuberculosis •• Apical Apical pleural pleural thickening thickening •• Calcified Calcified granuloma—Ghon granuloma—Ghon lesion lesion •• Calcified Calcified granuloma granuloma and and hilar hilar node node calcification—Ranke calcification—Ranke complex complex •• Fibrosis Fibrosis and and volume volume loss loss Healed TB: Ghon Lesion Healed TB: Ranke Complex Healed TB: Apical Pleural Thickening Healed TB: Apical Pleural Thickening