Radiographic manifestations of pulmonary tuberculosis

1. RADIOGRAPHIC MANIFESTATIONS OF
PULMONARY TUBERCULOSIS
DR. DEVKANT LAKHERA

2. CAUSE AND
TRANSMISSION OF
TUBERCULOSIS AND
PROGRESSION OF
LATENT INFECTION

3. Radiological
patterns
may be
considered
under the
following
groups:
1. Typical radiological patterns of primary TB.
2. Post primary TB or Reactivation TB.
3. Patterns encountered in both primary and/or
postprimary TB.
4. Complications and sequelae of TB.

4. PRIMARY TB
• The most common
abnormality in children is
lymph node enlargement,
which is seen in 90–95%
of cases.

5. • 10-year-old child
with tuberculosis,
shows widening of
the right
paratracheal stripe

6. CECT show tuberculous nodes
that show central areas of low
attenuation suggestive of
caseous necrosis and peripheral
rim enhancement

8. GHON FOCUS
• Ghon focus may be visualized on
the chest radiograph as an airspace
opacity

9. GHON LESION/FOCUS
• Small tan-yellow subpleural
granuloma in the mid-lung field on
the right.
• Over time, the granulomas decrease
in size and can calcify, leaving a focal
calcified spot on a chest radiograph
that suggests remote granulomatous
disease.

10. GHON COMPLEX
• typical of primary
tuberculosis in a child
• Parenchymal involvement is
more in adults.

11. RANKE
COMPLEX
• The combination of calcific lesions
of the lung and lymph node is
referred to as the “Ranke complex”

12. • Airspace consolidation is usually
unilateral, is evident radiographically
in approximately 70% of children
with primary TB

13. • obtained at level of right middle lobar
bronchus

14. PLEURAL EFFUSION IN TB
Pleural effusion is usually
unilateral and due to
subpleural infection.
Pleural effusions are more
common in adults with
primary tuberculosis (40%).

15. shows a right upper lobe airspace
opacity adjacent to the trachea. In
addition, there is
elevation of the minor fissure (arrows),
(ATELECTASIS)
VOLUME LOSS

16. POST-PRIMARY
TUBERCULOSIS
• focal or patchy heterogeneous
consolidation involving the
apicoposterior segments of the
upper lobes and the superior
segments of the lower lobes

17. • lateral view of the same
patient, the typical location of
the apicoposterior segment

18. •Predilection for upper
lobes
•Lack of lymphadenopathy
•Propensity for cavitation
Post-primary
tuberculosis
distinguishing
features
POST-PRIMARY TUBERCULOSIS/REACTIVATION
TUBERCULOSIS

19. • The predilection for the upper lobes is thought to be due to
decreased lymph flow in the upper regions of the lung.
• An alternative explanation is the presence of higher oxygen
tension in that region.

20. CAVITATION
• Xray showing cavitatory
consolidation in right upper lung
zone and multiple ill-defined
nodules in both lungs

21. Cavitation and tree in bud sign is indicative of an active
disease process and usually heals as a linear or fibrotic
lesion.

22. MILIARY
TUBERCULOSIS
Miliary TB refers to
widespread
dissemination of TB by
hematogenous spread.
Seen more frequently in
reactivation TB
Seen in pts with
Location

23. The characteristic
radiographic and high
resolution CT findings
consist of innumerable,
1- to 3-mm diameter
nodules randomly
distributed throughout
both lungs

24. chest radiograph shows
innumerable millet-sized
nodular opacities and
ground-glass opacities in
both lungs

25. Sequelae of healed primary TB, but
may be seen in 3–6 percent of cases of
postprimary tuberculosis as the main
or only abnormality
TUBERCULOMA

27. HEALED TB
calcified nodule consistent
with a calcified granuloma.
In addition, there is
bilateral apical pleural
thickening

29. COMPLICATIONS AND SEQUELAE

30. ASPERGILLOMA
tuberculous cavity
can be colonized by
Aspergillus species
and present as an
“aspergilloma”

31. spherical nodule or a mass
separated by a crescent-
shaped area of decreased
opacity or air from the
adjacent cavity wall

33. BRONCHIECTASIS
Bronchiectasis is seen in 30%–60% of patients with active postprimary
tuberculosis and in 71%–86% of patients with inactive disease at high-
resolution CT

34. HRCT shows traction
bronchiectasis in
the right upper lobe

35. This case demonstrates
a left pleural effusion with air-fluid
levels consistent with a
hydropneumothorax caused by the
bronchopleural fistula.
Diagnosis of hydropneumothorax is
based on the presence of a pleural
effusion accompanied by an air-fluid
level within the pleural space.
TUBERCULOUS EMPYEMA

36. BRONCHOPLEURAL
FISTULA
Empyema may also communicate
with the bronchial tree by
bronchopleural fistula and can show
an air fluid level

37. VASCULAR COMPLICATIONS

38. Bronchial arteries
may be enlarged in bronchiectasis associated
with TB

39. RASMUSSEN ANEURYSM
Rasmussen aneurysm is a
pseudoaneurysm that results
from weakening of the pulmonary
artery wall by adjacent cavitatory
TB

40. CECT obtained shows cavitatory
consolidation
with air-crescent sign in left
upper lobe.

41. Pneumothorax occurs
in approximately 5
percent of patients
with postprimary TB,
usually in severe
cavitatory disease.
PNEUMOTHORAX

42. PLEURAL EMPYEMA
Bacilli can enter the pleural
space from a juxtapleural
caseating granuloma, or
via hematogenous
dissemination

43. TRACHEOBRONCHIAL
STENOSIS

44. BRONCHOGENIC CARCINOMA
• Tuberculosis may predispose to the development of
bronchogenic carcinoma by local mechanisms (scar cancer)
• Carcinoma may lead to reactivation of TB, both by eroding into
an encapsulated focus and by affecting the patient’s immunity.

46. BRONCHOLITH

47. PERICARDITIS
Tuberculous
pericarditis reported to
complicate 1 percent
of cases of TB is
commonly caused by
extranodal extension
of tuberculous adenitis
into the pericardium

49. • As the CD4 lymphocyte count declines, the radiographic
findings look more like those seen in primary disease.
• The radiographic opacities may be in the lower lung zones
and multilobar in nature.
• Lymphadenopathy is more common.
TUBERCULOSIS AND HIV

51. THANK YOU

54. BRONCHOPLEURAL FISTULA

57. TUBERCULOSIS IN INDIA
• India is responsible for 1/3rd of the global cases of
tuberculosis
• 1.8 million new cases of tuberculosis are reported every
year

58. PULMONARY TUBERCULOSIS
• 95% - MYCOBACTERIUM TUBERCULOSIS
• 5% - ATYPICAL MYCOBATERIUM

59. LYMPH NODES ENLARGEMENT

60. GANGLIOPULMONARY T.B
• Very specific to primary t.b
mediastinal and/or hilar
adenopathies and less
conspicuous parenchymal
abnormalities.
• preferential occurrence in
children, it has been designated
as “childhood”-type TB;