1 Guy Richards Radiological Features of Mycobacterium tuberculosis Department of critical care Charlotte Maxeke Johannesburg Academic Hospital University of the Witwatersrand, Johannesburg, South Africa • phthisis • consumption • “A condition of little knobs and swellings” • King’s evil • White plague TUBERCULE BACILLUS Discovery of Robert Koch, German bacteriologist (1843-1910) in the year 1882 Tuberculosis Mycobacterium tuberculosis TUBERCULE BACILLUS Mycobacterium tuberculosis Famous people who had Tuberculosis Frederick Chopin Franz Kafka John Keats Bronte family PATHOGENESIS of TUBERCULOSIS Lymph nodes Swallowed Expelled Intestine Calcified lesion Stable Perhaps years later Reactivation Progress Inhaled organisms To alveoli Distant spread Enlargement & Local spread Distant spread Distant spread Primary complex Healing • demonstrate AFB • positive culture • skin test • serology • PCR DIAGNOSIS Mycobacterium tuberculosis
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Radiological Features of Mycobacterium tuberculosis · 21 cases due to TB ACUTE PNEUMONIA IN ICU Dalmash et al, 1993 113 patients 8% due to TB Rello et al, 1993 58 patients 11.4%
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1
Guy Richards
Radiological Features of
Mycobacterium tuberculosis
Department of critical care
Charlotte Maxeke Johannesburg Academic Hospital
University of the Witwatersrand,
Johannesburg, South Africa
• phthisis
• consumption
• “A condition of little knobs and swellings”
• King’s evil
• White plague
TUBERCULE BACILLUS
Discovery of Robert Koch,
German bacteriologist (1843-1910)
in the year 1882
Tuberculosis
Mycobacterium tuberculosis
TUBERCULE BACILLUS
Mycobacterium tuberculosis
Famous people who had Tuberculosis
Frederick Chopin
Franz Kafka
John Keats
Bronte family
PATHOGENESIS of TUBERCULOSIS
Lymph nodesSwallowedExpelled
Intestine
Calcified
lesion
Stable
Perhaps years
later
ReactivationProgress
Inhaled
organisms
To alveoli
Distant spread
Enlargement &
Local spreadDistant spread
Distant
spread
Primary
complex
Healing
• demonstrate AFB
• positive culture
• skin test
• serology
• PCR
DIAGNOSIS
Mycobacterium tuberculosis
2
Primary tuberculosis
• lymphadenopathy (big)
• parenchymal disease (small)
• pleural effusion
• atelectasis
• miliary disease
• normal radiograph in ~15%
CLASSIFICATION OF PULMONARY TB
Mycobacterium tuberculosis
Primary tuberculosis
• Areas of greatest lung
ventilation
• Middle lobe
• Lower lobes
• Anterior segment of upper lobes
CLASSIFICATION OF PULMONARY TB
Mycobacterium tuberculosis
Primary tuberculosis
• hilar and mediastinal lymph-
adenopathy (>2 cm), which
present with a hypodense centre
(caseation) and rim enhancement
• obstructive atelectasis may
occur
• cavitation is uncommon
CLASSIFICATION OF PULMONARY TB
Mycobacterium tuberculosis
Harisinghani M G et al. Radiographics 2000;20:449-470