1 Tuberculosis - Imaging Sudhakar Pipavath, MD Department of Radiology, University of Washington, Seattle Disclosure Consultant Boehringer Ingelheim 1 2
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Tuberculosis - Imaging
Sudhakar Pipavath, MDDepartment of Radiology,
University of Washington, Seattle
Disclosure
Consultant Boehringer Ingelheim
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A posterior-anterior chest radiograph is used to detect chest abnormalities. Lesions may appear anywhere in the lungs and may differ in size, shape, density, and cavitation. These abnormalities may suggest TB, but cannot be used to definitively diagnose TB. However, a chest radiograph may be used to rule out the possibility of pulmonary TB in a person who has had a positive reaction to a TST or special TB blood test and no symptoms of disease
http://www.cdc.gov/tb/publications/factsheets/testing/diagnosis.htm
TB - IntroductionMycobacterium tuberculosis
AIDS epidemic – Resurgence
Prefers chest but can affect any organ system
In AIDS, extrapulmonaryinvolvement is more common
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TB Types
Primary
Re-activation
Imaging IssuesPrimary Vs. Re-activation
Active Vs. Inactive Vs. Indeterminate
Mimics of TB
When do I call the clinician?
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Primary TB
More common in infants and children
Increasing in adults (23-34%)
Primary TB - Imaging
Parenchymal disease
Lymphadenopathy
Pleural effusion
Miliary disease
Atelectasis lobar or segmental
Chest radiograph may be normal (15%)
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Primary TB
Primary TB
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Primary TB
CT in Primary Tuberculosis
Confirms the presence of parenchymal disease, as well as lymphadenopathy
Lymph nodes - characterization
Additional abnormalities:DisseminationExtrapulmonary
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Postprimary –Re-activation TB
Patients in whom initial infection contained successfully by pulmonary macrophages
Bacilli remain viable within the macrophages
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Re-activation TBDistinguishing Imaging Features
Predilection for the upper lobes
Absence of lymphadenopathy
Cavitation
TB
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Courtesy Tan Muhammed, MD, Virginia Mason Medical Center
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Endobronchial spread of infection
Organisms pass via the airways
Imaging shows centrilobularnodules, tree-in-bud, ill-defined acinar shadows
May become confluent and mimic “pneumonia”
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Reactiv tbc
Cavitation
Bronchiectasis, bronchial stenosis etc.
Endobronchial spread of TB
Tree-in-Bud
CT Features: Re-activationTB
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Tree-in-Bud
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Tree-in-Bud
Twig = airway
Leaf = Centrilobular Bronchiole
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Pleural TB - Imaging
Effusion
Empyema
Thickening
Calcification
Bronchopleural fistula (BPF)
Lung disease at CT is a useful clue
Primary>>Reactivation
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Pleural and Lung involvement
Bronchopleural Fistula
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TB in the HIV patient
MDR TB-doesn'tlook any different
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TB in the HIV patient
TB in the HIV patient
CD4 count : 150 cells/mm3
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Not everything is TB!
Aspiration pneumonia
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Pneumonia
Atypical Mycobacteria
Mycobacterium kansasii
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Panbronchiolitis
Kartagener’s Syndrome
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Aspergillus Infection
Summary
Chest radiograph is a great initial tool
Radiologic features of TB mimic other diseases
CT often helps in further characterization
Understanding the spectrum of imaging features of TB aids in making early diagnosis
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