Dr Saket Kumar Jain (Resident)
Dept. Of Radio-Diagnosis
Two types – primary and post primary
Patients who develop disease after initial exposure are considered to
have primary TB .
Primary site of infection in the lungs is called the Ghon focus.
The combination of the Ghon’s focus and affected lymph nodes is
known as the primary complex .
“ Ranke complex ”
parenchyma consolidation in
patchy, poorly defined
in the apical and
posterior segments of the
however, predominance in the
lower and middle lobes is
suggestive of the disease,
especially in adults
in majority- more than
one pulmonary segment
is involved, with bilateral
disease seen in one-third
to two-thirds of cases.
appearance is often
indistinguishable from that of
Cavitation, the hallmark of postprimary
typically have thick, irregular walls, which
become smooth and thin with successful
is seen in up to 96% of children and
43% of adults
typically unilateral and right sided,
involving the hilum and right
although it is bilateral in about one-third
it can be the sole radiographic finding
more common in infants and decreases
in frequency with age
seen in only
about 5% of
seen in approximately
one-fourth of patients
seen in approximately
18% of patients with
often the sole
usually small and
very uncommon finding
in infants & is usually
effusions are typically
Widespread hematogenous dissemination of
So named because the nodules are the size of millet seeds
(1mm to 3 mm)
Diffuse, random distribution
Takes weeks between the time of dissemination and the radiographic
appearance of disease
When first visible, they measure about 1 mm in size; they can grow to
2-3mm if left untreated
No matter what form of TB the patient has, it tends to
look like 1° TB
Hilar and mediastinal adenopathy are common
Cavitation is less common
There is no predilection for the apices
Atypical mycobacterium( MAI - mycobacterium aviumintracellulare) is more common in HIV than
Consolidation - ? acute pneumonia .
The term consolidation does not imply any particular aetiology
or pathology .
Acute pneumonia is the commonest cause but not the only cause
of consolidation --- ( other causes include chronic pneumonia,
pulmonary oedema and neoplasm)
what is consolidation ?
Refers to fluid in the airspaces of the lung
Consolidation may be complete or incomplete
The distribution of the consolidation can vary widely.
A consolidation could be described as “patchy”,
“homogenous”, or generalized”.
A consolidation may be described as focal or by the lobe or
segment of lobe affected
Air bronchogram refers to the phenomenon of air-filled bronchi
(dark) being made visible by the opacification of surrounding
alveoli (grey - white).
Micro-organisms responsible may enter the lung by three potential
via the tracheobronchial tree
via the pulmonary vasculature
via direct spread from infection in the mediastinum, chest wall, or
Outbreaks in winter
Risk in DM, Elderly, IC
Dry cough, headache,
myalgia, fever, croup and otitis media
Croup , coughing , dyspnea , wheezing ,
Superadded bact inf. Can occur
In children with croup may show subglottic
tracheal narowing so called STEEPLE sign
Multifocal patchy consolidation may be
Multifocal patchy consolidation may be
Plerual effusion uncommon
Winter & spring
Imp. Cause of both URTI &LRTI in infants &
In children-URTI- pharyngitis, rhinitis, otitis
Fever, myalgia, headache, conjuctivitis
LRTI- coughing, dyspnea, wheezing,
Rhinorrhea followed by skin rash
Perihilar linear opacities , bronchial wall
thickening, patchy areas of consolidation
B/L patchy air space consolidation
associated in perihilar
In children-may be lymph node
Affects oral cavity ,LRTI occurs if organism is transported into trachea &
They are severly immunocompromised
Multifocal consolidation due to bronchopneumonia
• Herpes simplex – 2 – acquired during child birth
Varicella zoster virus – pneumonia presents as high fever rapidly
followed by skin rash
Appear as diffuse small nodules in the range of 5-10 mm that progress
to air space consolidation rather rapidly
Hilar lymphadenopathy is common
Pleural effusion is rare
is the central compartment of the
"BATS & TENT":
Arch of aorta
Nerves (vagus &
3 ; T’s
great vessels :
superior vena cava
• Plain chest x-ray.
• CT of the chest ( procedure of choice for mediastinal
• MRI (may enhance the diagnostic abilities of chest CT)
▪ FNA or needle biopsy with CT guidance .
A normal thymus is visible in 50% of pediatric age group of 0–
2 years of age.
The size and shape of the thymus are highly variable
The thymus is seen as a triangular sail (thymic sail sign) frequently
towards the right of the mediastinum. It has no mass effect on
vascular structures or airway.
The most common neoplasm of the anterosuperior compartment
Radiograph: small, well-circumscribed mass or as a bulky
lobulated mass confluent with adjacent mediastinal structures
• chest pain
• superior vena cava syndrome
• systemic syndromes caused by immunologic mechanisms
Enlarged thyroid usually are considered retrosternal (also referred to
as mediastinal, intrathoracic, or substernal) when more than 50% of
the thyroid parenchyma is located below the sternal notch
Presentation - Substernal Goiters
Choking sensation, particularly in
Vague chest pain or heaviness
• Airway obstruction
The mediastinum is commonly involved in lymphoma, either as
part of disseminated disease or less commonly as the site of
retrosternal chest pain
SVC Compression with SVC SYNDROME
A soft tissue mass may be clearly visible, or more frequently the
mediastinum is widened, and the retrosternal space is obscured.
This is a broad term used to encompass a number of congenital
mediastinal cysts derived from the embryological foregut.
They include bronchogenic, esophageal duplication and
neuroenteric cysts .
Bronchogenic cysts are the most common.
These are congenital out-pouchings from the parietal pericardium
A hiatus hernia occurs where there is herniation of stomach through
the esophageal hiatus of the diaphragm
Any cranial nerve may be involved, except CNI
and CN2 which lack sheaths composed of
CN VIII (acoustic neuroma) most commonly the
superior portion of vestibular nerve (most
CN V (2nd most common)
CN VII (3rd most common)
Presentation depends on location of the tumor.
Pneumomediastinum is the presence of extra luminal gas within
the mediastinum. Gas may come from lungs, trachea,
central bronchi, esophagus, and the neck or abdomen.
“Continuous diaphragm sign” of
spinnaker sign (also known as the
angel wing sign)
TUBERCULOSIS VERY COMMON – HIGH
INDEX OF SUSPICIONCLINICAL PRESENTATION
Its easy to diagnose consolidation but
difficult to interpret it , correlation with
clinical symptoms is the key point
MEDIASTINUM - To diagnose a pathology ,
very difficult - complete work-up
HISTORY , X-RAY + further investigation
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