Chest 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
ƒƒ apical/posterior
apical/posterior segments
segments of
of upper
upper lobes
lobes
ƒƒ superior
superior segments
segments of
of lower
lower lobes
lobes
ƒƒ right
right side
side more
more common
common
ƒƒ 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
ƒƒ air
air space
space consolidation
consolidation
ƒƒ cavitation
cavitation,, cavitary
cavitary nodule
nodule
ƒƒ endobronchial
endobronchial spread
spread
ƒƒ miliary
miliary
ƒƒ bronchostenosis
bronchostenosis
ƒƒ 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

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