3. Introduction
Up until the mid 1980s, there was a steady
decline in the prevalence of T.B.
Since then, there has been a resurgence
of T.B. due to
AIDS epidemics
Increasing no. of resistant strains of
mycobacterium T.B.
Groups of increased risk e.g. poor, alcoholics,
homeless
4. Why is T.B. still considered a major issue?
T.B remains the major cause of death from a
single infectious agent among adults in
developing nations.
In 1993, the WHO declared T.B to be a
global emergency.
It is estimated that between 1997-2020,
nearly 1 billion people will become newly
infected and 70 x 106 will die from the
disease (WHO, 1998)
8. Radiology of Primary T.B.
1) Lymphadenopathy:
Is the radiological hallmark of the disease
83-96% of pediatric cases
9. Radiology of Primary T.B.
1) Lymphadenopathy:
Is the radiological hallmark of the disease
hilar lymphadenopathy
10. Radiology of Primary T.B.
1) Lymphadenopathy:
Is the radiological hallmark of the disease
83-96% of pediatric cases
Prevalence
with
age
Rt. paratracheal + hilar stations are most common sites
11. Radiology of Primary T.B.
1) Lymphadenopathy:
Is the radiological hallmark of the disease
hilar lymphadenopathy
12. Radiology of Primary T.B.
1) Lymphadenopathy:
Is the radiological hallmark of the disease
83-96% of pediatric cases
Prevalence
with
age
Rt. paratracheal + hilar stations are most common sites
CT has a characteristic appearance
13. Radiology of Primary T.B.
1) Lymphadenopathy:
Is the radiological hallmark of the disease
Precontrast
Postcontrast
14. Radiology of Primary T.B.
1) Lymphadenopathy:
Is the radiological hallmark of the disease
83-96% of pediatric cases
Prevalence
with
age
Rt. paratracheal + hilar stations are most common sites
CT has a characteristic appearance
D.D.: 1- Metastases
2- Lymphoma
3- other infections e.g.
4- Sarcoidosis
- Varicella pneumonia
- histopalmsmosis
15. Radiology of Primary T.B.
2) Parenchymal disease:
Affects areas of greatest ventilation
upper lobe
38-81% of adult cases
Rt. Sided predominance
Homogenous consolidation in segmental or lobar pattern
16. Radiology of Primary T.B.
2) Parenchymal disease:
consolidation
Para.T LN
hilar LN
consolidation
Displaced OF
17. Radiology of Primary T.B.
2) Parenchymal disease:
Affects areas of greatest ventilation, middle & lower
lobes & anterior segment of upper lobe
38-81% of adult cases
Rt. Sided predominance
Homogenous consolidation in segmental or lobar pattern
Tuberculo
ma
- Round or oval sharply marginated
- 0.5- 4 cm
- + calcifications
- Surrounding satellites
23. Radiology of Primary T.B.
4) Miliary T.B.:
Innumerable 1-3 mm, non-calcified nodules scattered
through both lung fields with basal predominance
High resolution CT.
24.
25. Post Primary T.B.
Exclusively a disease of adolescens + adults
Results from
90%
%
10
Reactivation of a previously
dormant 1ry infection
Continuation of 1ry disease
Radiological features:
1- Parenchymal disease with cavitation
2- Air way involvement
3- Pleural extension
Endo bronchial spread
4- Complications
Aspergilosis
26. Radiology of Post Primary T.B.
1) Parenchymal disease :
Consolidation: Patchy, ill-defined, segmental
Predilection * to upper lobes
* Apical segment of lower lobe
a- O2 tension
b- Impaired lymphatic drainage
Tw0 or more segments are involved in most of cases
Bilateral upper lobe disease may be present
Cavitations:
• Multiple with thick irregular walls
• May show air fluid level
27. Radiology of Post Primary T.B.
1) Parenchymal disease with cavitations:
thick-walled
cavity
Cavitary postprimary TB
28. Radiology of Post Primary T.B.
1) Parenchymal disease with cavitation:
nodule
cavity
cavity
air-fluid level
29. Radiology of Post Primary T.B.
1) Parenchymal disease with cavitations:
Consolidation: Patchy, ill-defined, segmental
Predilection * to upper lobes
* Apical segment of lower lobe
a- O2 tension
b- Impaired lymphatic drainage
Tw0 or more segments are involved in most of cases
Bilateral upper lobe disease may be present
Cavitations: •Multiple with thick irregular walls
•May show air fluid level
30. Radiology of Post Primary T.B.
1) Parenchymal disease with cavitation:
Thick walled cavity
air-fluid level
31. Radiology of Post Primary T.B.
2) Air way involvement:
Bronchial stenosis
Collapse
Consolidation
due to
Hyperinflation
1- direct extension from TB LN
2- Endobronchial spread of infection
3- lymphatic dissemination to the airway
32. Radiology of Post Primary T.B.
2) Air way involvement:
narrowing
Tuberculous bronchostenosis.
33. Radiology of Post Primary T.B.
2) Air way involvement:
partial atelectasis
calcified LN
calcified LN
calcified LN
Eroding into bronchus
calcified LN
Tuberculous broncholithiasis
34. Radiology of Post Primary T.B.
2) Air way involvement:
D.D. Carcinoma
1- Longer segment of involvement
2- Circumferential luminal narrowing
3- No intraluminal mass
}
TB
35.
36. Radiology of Post Primary T.B.
3) Pleural extension:
Pleural effusion
Small associated with parenchymal disease
Empyema loculated
Subpleural cavitation
Air fluid level in pleura = bronchopleural fistula
37. Radiology of Post Primary T.B.
3) Pleural extension:
Pleural effusion
air
Subpleural cavitating nodule
bronchus
Enhancing pleura
TB empyema with bronchopleural fistula
38. Radiology of Post Primary T.B.
4) Complications: If left untreated disease progress to
Lobar or complete lung opacification + destruction
bronchiectatic changes
bronchiectatic changes
Lung destruction in postprimary TB
39. Radiology of Post Primary T.B.
4) Complications: If left untreated disease progress to
Lobar or complete lung opacification + destruction
Coarse reticular + nodular opacified areas fibroproliferative
dse
40. Radiology of Post Primary T.B.
4) Complications:
volume loss +
apical pleural
thickening
reticulonodular infiltrates
Cavitating nodule
Fibroproliferative disease.
41. Radiology of Post Primary T.B.
4) Complications: If left untreated disease progress to
Lobar or complete lung opacification + destruction
Coarse reticular + nodular opacified areas fibroproliferative
dse
Healing of lesions traction bronchiactasis
42. Radiology of Post Primary T.B.
4) Complications:
bronchiectasis
bronchiectasis
fungal ball
Complications of childhood TB
Bronchiectasis in postprimary TB.
43. Radiology of Post Primary T.B.
4) Complications: If left untreated disease progress to
Lobar or complete lung opacification + destruction
Coarse reticular + nodular opacified areas fibroproliferative
dse
Healing of lesions traction bronchiactasis
Endobronchial spread commonest complication of T.B
cavitation
44. Radiology of Post Primary T.B.
4) Complications:
tree-in-bud”
LN
endobronchial
spread
cavities
cavity
Cavitary postprimary tuberculosis
45. Radiology of Post Primary T.B.
4) Complications: If left untreated disease progress to
Lobar or complete lung opacification + destruction
Coarse reticular + nodular opacified areas fibroproliferative
dse
Healing of lesions traction bronchiactasis
Endobronchial spread commonest complication of T.B
cavitation
Small, poorly defined centrilobular nodules + branching
centrilobular areas of increased opacity “tree-in-bud”
appearance
46. Radiology of Post Primary T.B.
4) Complications:
tree-in-bud
Endobronchial spread of tuberculosis
bronchiolar
wall thickening
47. Radiology of Post Primary T.B.
4) Complications: If left untreated disease progress to
Lobar or complete lung opacification + destruction
Coarse reticular + nodular opacified areas fibroproliferative
dse
Healing of lesions traction bronchiactasis
Endobronchial spread commonest complication of T.B
cavitation
Mycetoma
Aspergillus superimposed infection
48. Radiology of Post Primary T.B.
4) Complications:
nodule in the cavity
Complications of childhood TB
49. Radiology of Post Primary T.B.
4) Complications:
Cavitary TB associated with aspergilloma
Post primary TB
air crescent sign
air crescent sign
aspergilloma
aspergilloma
50. Radiology of Post Primary T.B.
4) Complications: If left untreated disease progress to
Lobar or complete lung opacification + destruction
Coarse reticular + nodular opacified areas fibroproliferative
dse
Healing of lesions traction bronchiactasis
Endobronchial spread commonest complication of T.B
cavitation
Mycetoma
Broncholithiasi
s alcified T.B LN in the mediastinum may occasionally erode
C
into adjacent airway.
51. Radiology of Post Primary T.B.
4) Complications:
Tuberculous broncholithiasis
calcified LN
calcified LN
Eroding into a bronchus
52. Can X-ray D.D. active / inactive T.B?
1-D.D can be reliably made on basis of
temporal evolution i.e. lack of radiographic
change over 4-6 months.
Thus radiology can say that the dse. is stable
rather than inactive .
2-Fibrosis +calcification are found in both
healed + active disease
53. Can X-ray D.D. active + inactive T.B?
Sputum culture–positive TB
Fibrosis +calcification are found in both healed + active dse
Fibrosis
retroclavicular calcifications
calcified nodules
Fibrosis
Close-up radiographic view
CT scan with 1-mm collimation
54. Can X-ray play role in assessing
treatment response?
nodules
Pre-Treatment
confluent
consolidation
Postprimary TB
3 months Post- treatment
Regression of radiographic abnormalities in
pulmonary TB is a slow process
55. Can X-ray play role in assessing
treatment response?
Worsening of X-Ray findings :
1st 3 months of treatment
- Progress of parenchymal
involvement
-development or enlargement of
LN
cause
Unknown , may be due to:
development of
hypersensitivity reaction
2-10 weeks after initial
infection
56. Can X-ray play role in assessing
treatment response?
worsening of the radiographic
1st 3 months of treatment
findings i.e. extension of
parenchymal involvement
+development or enlargement
of LN
6m-2 years of treatmentresolution of parenchymal
abnormalities on X-ray this is
seen earlier on CT (15 months)
Failure of improvement of radiographic
drug resistant
findings after 3 months of treatmentorganism
superimposed infection
57.
58. 2ry to 1. Pleural disease +empyema
2. Haematogenous spread of disease
Characterized by
1. Destruction of bone or costal cartilage
2. Soft tissue masses may show calcifications +
rim enhancement
3. Fistulation
59. TB of the sternoclavicular J
soft-tissue mass
Clavical with irregular margin
60.
61. Rarely involves the heart
Tuberculoma of the Rt atrium
in a patient with miliary T.B.
mass
pleural effusion
MRI-Axial T2WI
62. Rarely involves the heart
Pericardial involvement may be seen with
mediastinal + pulmonary TB
pericardial thickening
Tuberculous pericarditis in a
patient with pleuropulmonary T.B.
pleural effusion
Axial CT scan
tuberculoma
63.
64. T.B. spondylitis (Pott’s disease):
Spine is the comment site of osseous involvement in T.B
or
Upper lumbar + lower dorsal are most frequently involved
Vertebral body is more commonly affected than post. elements
Disease process begins in ant. part of the vertebral body
extension beneath
infection spread to disc space by
the ant./ post. L. L.
Collapse of disc
penetration of
subchondral bone plate
65. T.B. spondylitis (Pott’s disease):
Spine is the comment site of osseous involvement in T.B
Upper lumbar + lower dorsal are most frequently involved
Vertebral body is more commonly affected than post. elements
Disease process begins in ant. part of the vertebral body
Disease progression vertebral collapse
66. Oblite
ra
disk s ted
pace
T.B. spondylitis (Pott’s disease):
Destructed
end plates
Tuberculous spondylitis.
Lateral radiograph
67. T.B. spondylitis (Pott’s disease):
Spine is the comment site of osseous involvement in T.B
Upper lumbar + lower dorsal are most frequently involved
Vertebral body is more commonly affected than post. elements
Disease process begins in ant. part of the vertebral body
Disease progression vertebral collapse
with ant. wedging gibbus deformity
Extension may be subligamentous to distant vertebra
68. T.B. spondylitis (Pott’s disease):
on
erosi
Subligamentous spread of spinal T.B.
Lateral radiograph
69. T.B. spondylitis (Pott’s disease):
Spine is the comment site of osseous involvement in T.B
Upper lumbar + lower dorsal are most frequently involved
Vertebral body is more commonly affected than post. elements
Disease process begins in ant. part of the vertebral body
Disease progression vertebral collapse
In the thoracic region
Paravertebral abscess
=Post.mediastinal mass
70. T.B. spondylitis (Pott’s disease):
s
s
es
c
bs
a
ue
s
-tis
oft
lytic destruction
Tuberculous spondylitis.
Axial CT scan
71. T.B. spondylitis (Pott’s disease):
Spine is the comment site of osseous involvement in T.B
Upper lumbar + lower dorsal are most frequently involved
Vertebral body is more commonly affected than post. elements
Disease process begins in ant. part of the vertebral body
Disease progression vertebral collapse
In the thoracic region
Paravertebral abscess
=Post.mediastinal muscles
In the lumbar region
=Psoas abscess
73. T.B. spondylitis (Pott’s disease):
Spine is the comment site of osseous involvement in T.B
Upper lumbar + lower dorsal are most frequently involved
Vertebral body is more commonly affected than post. elements
Disease process begins in ant. part of the vertebral body
Disease progression vertebral collapse
In the thoracic region
Paravertebral abscess
=Post.mediastinal muscles
In the lumbar region
=Psoas abscess
may calcify when healed
74. T.B. spondylitis (Pott’s disease):
s+
scesse
ab
ation
calcific
ab
ca sce
lci ss
fic es
at +
ion
Calcified psoas abscess.
Axial CT scan
75. T.B. spondylitis (Pott’s disease):
Spine is the comment site of osseous involvement in T.B
Upper lumbar + lower dorsal are most frequently involved
Vertebral body is more commonly affected than post. elements
Disease process begins in ant. part of the vertebral body
Disease progression vertebral collapse
Paravertebral abscess
MR helps in diagnosis = focal area of low T1 + high T2 SI
with increased SI of disc
76. T.B. spondylitis (Pott’s disease):
al
spin
intra sion
n
exte
dis
k
nar
row
ing
D.D.
Tuberculous spondylitis.
Sagittal T2WI
1- Pyogenic vertebral
osteomyelitis
2- Metastases
3- Sarcoid
4- Tumor = lymphoma,
multiple myeloma, chordoma
5- Other infections =
brucellosis, fungus, hydatid
