Pulmonary TB
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Pulmonary TB

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Pulmonary TB Presentation Transcript

  • 1. ‫بسم ا الرحمن‬ ‫الرحيم‬
  • 2. 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
  • 3. 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)
  • 4. Primary Post primary (reactivation) There is considerable overlap in radiologic manifestations of these 2 entities. Results of radiography may be normal in 15% of cases
  • 5. Primary T.B.
  • 6. Radiology of Primary T.B. Lymphadenopathy Parenchymal disease Pleural effusion Miliary T.B
  • 7. Radiology of Primary T.B. 1) Lymphadenopathy: Is the radiological hallmark of the disease 83-96% of pediatric cases
  • 8. Radiology of Primary T.B. 1) Lymphadenopathy: Is the radiological hallmark of the disease hilar lymphadenopathy
  • 9. 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
  • 10. Radiology of Primary T.B. 1) Lymphadenopathy: Is the radiological hallmark of the disease hilar lymphadenopathy
  • 11. 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
  • 12. Radiology of Primary T.B. 1) Lymphadenopathy: Is the radiological hallmark of the disease Precontrast Postcontrast
  • 13. 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
  • 14. 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
  • 15. Radiology of Primary T.B. 2) Parenchymal disease: consolidation Para.T LN hilar LN consolidation Displaced OF
  • 16. 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
  • 17. Radiology of Primary T.B. 2) Parenchymal disease: nodule DD: Nodule nodule nodule 1. 2. 3. 4. Tuberculoma Hamartoma Metastases Hydatid
  • 18. 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 Obstructive atelectasis 2ry compression of adjacent enlarged LN
  • 19. Radiology of Primary T.B. 2) Parenchymal disease: cavity LNs Displaced OF LNs collapse collapse
  • 20. Radiology of Primary T.B. 3) Pleural effusion: Unilateral pleural effusion hilar LNs Enhancing parietal pleura pleural effusion
  • 21. 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.
  • 22. 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
  • 23. 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
  • 24. Radiology of Post Primary T.B. 1) Parenchymal disease with cavitations: thick-walled cavity Cavitary postprimary TB
  • 25. Radiology of Post Primary T.B. 1) Parenchymal disease with cavitation: nodule cavity cavity air-fluid level
  • 26. 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
  • 27. Radiology of Post Primary T.B. 1) Parenchymal disease with cavitation: Thick walled cavity air-fluid level
  • 28. 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
  • 29. Radiology of Post Primary T.B. 2) Air way involvement: narrowing Tuberculous bronchostenosis.
  • 30. 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
  • 31. 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
  • 32. 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
  • 33. Radiology of Post Primary T.B. 3) Pleural extension: Pleural effusion air Subpleural cavitating nodule bronchus Enhancing pleura TB empyema with bronchopleural fistula
  • 34. 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
  • 35. 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
  • 36. Radiology of Post Primary T.B. 4) Complications: volume loss + apical pleural thickening reticulonodular infiltrates Cavitating nodule Fibroproliferative disease.
  • 37. 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
  • 38. Radiology of Post Primary T.B. 4) Complications: bronchiectasis bronchiectasis fungal ball Complications of childhood TB Bronchiectasis 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 Healing of lesions  traction bronchiactasis Endobronchial spread commonest complication of T.B cavitation
  • 40. Radiology of Post Primary T.B. 4) Complications: tree-in-bud” LN endobronchial spread cavities cavity Cavitary postprimary tuberculosis
  • 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 Endobronchial spread commonest complication of T.B cavitation Small, poorly defined centrilobular nodules + branching centrilobular areas of increased opacity “tree-in-bud” appearance
  • 42. Radiology of Post Primary T.B. 4) Complications: tree-in-bud Endobronchial spread of tuberculosis bronchiolar wall thickening
  • 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 Mycetoma Aspergillus superimposed infection
  • 44. Radiology of Post Primary T.B. 4) Complications: nodule in the cavity Complications of childhood TB
  • 45. Radiology of Post Primary T.B. 4) Complications: Cavitary TB associated with aspergilloma Post primary TB air crescent sign air crescent sign aspergilloma aspergilloma
  • 46. 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.
  • 47. Radiology of Post Primary T.B. 4) Complications: Tuberculous broncholithiasis calcified LN calcified LN Eroding into a bronchus
  • 48. 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
  • 49. 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
  • 50. 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
  • 51. 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
  • 52. 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
  • 53. 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
  • 54. TB of the sternoclavicular J soft-tissue mass Clavical with irregular margin
  • 55. Rarely involves the heart Tuberculoma of the Rt atrium in a patient with miliary T.B. mass pleural effusion MRI-Axial T2WI
  • 56. 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
  • 57. 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
  • 58. 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
  • 59. Oblite ra disk s ted pace T.B. spondylitis (Pott’s disease): Destructed end plates Tuberculous spondylitis. Lateral radiograph
  • 60. 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
  • 61. T.B. spondylitis (Pott’s disease): on erosi Subligamentous spread of spinal T.B. Lateral radiograph
  • 62. 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
  • 63. T.B. spondylitis (Pott’s disease): s s es c bs a ue s -tis oft lytic destruction Tuberculous spondylitis. Axial CT scan
  • 64. 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
  • 65. presacra l abscess erosion Iliopsoas abscess. Axial CT scan s se es sc ab abs ces se s T.B. spondylitis (Pott’s disease):
  • 66. 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
  • 67. 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
  • 68. 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
  • 69. 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