Tuberculosis (TB): clinical background,diagnosis and managementAbdusalam Halboup
Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as brain, bone, the kidney and. In 2017, the incidence of TB among population in Yemen is 48 cases per 100,000 people.
Tuberculosis (TB): clinical background,diagnosis and managementAbdusalam Halboup
Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as brain, bone, the kidney and. In 2017, the incidence of TB among population in Yemen is 48 cases per 100,000 people.
Mycobacterium tuberculosis-importance of TB day,classification of Mycobacterium species,Details on Mycobacterium tuberculosis-morphology,culture,resistance,biochemical reactions,antigenic characters,mode of transmission,pathogenesis,complications,lab diagnosis,treatment,DOTS Strategy and prophylaxis
Tuberculosis (TB) is an infectious disease usually caused by Mycobacterium tuberculosis (MTB) bacteria. Tuberculosis generally affects the lungs, but can also affect other parts of the body
Mycobacterium tuberculosis-importance of TB day,classification of Mycobacterium species,Details on Mycobacterium tuberculosis-morphology,culture,resistance,biochemical reactions,antigenic characters,mode of transmission,pathogenesis,complications,lab diagnosis,treatment,DOTS Strategy and prophylaxis
Tuberculosis (TB) is an infectious disease usually caused by Mycobacterium tuberculosis (MTB) bacteria. Tuberculosis generally affects the lungs, but can also affect other parts of the body
Pediatrics notes about "Tuberculosis". These notes were published in 2018.
You can download them also from
- Telegram: https://t.me/pediatric_notes_2018
- Mediafire: http://www.mediafire.com/folder/u5u60m184t9z7/Pediatric_Notes_2018
When a sound source and the reflector are moving toward each other, the sound waves are spaced closer together and reach the receiver at a higher frequency than they were originally emitted “
Female gynaecologic conditions arising from the endometrium are common and depend on a woman's age, her menstrual history, and the use of medications such as hormone replacement and tamoxifen.
Both benign and malignant conditions affect the endometrium.
Benign conditions must be distinguished from malignant and premalignant conditions.
The most commonly used imaging modality for evaluating the endometrium is pelvic ultrasound with transabdominal and transvaginal techniques. Additional imaging methods include hysterosonography and magnetic resonance imaging
enal transplantation is the most effective treatment option in patients with end-stage renal disease.
Studies have shown that the 5-year survival after renal transplantation is 70%, as compared to 30% survival in patients receiving dialysis.
The use of appropriate diagnostic method in preoperative analysis and also in postoperative follow up protocol is necessary for accurate preparation and early diagnosis of complications and workflow efficiency .
The most important role of diagnostic radiological methods is to identify multiple complications in the posttransplant period
Generally, the transplanted kidney is placed heterotopically in an extraperitoneal space in the pelvis; that is, a right kidney is placed in the left iliac fossa and vice versa
The right iliac fossa is usually preferred, since the right iliac vein runs a more superficial and horizontal course on this side of the pelvis, making the creation of vascular anastomoses easier.
WHY IS THIS topic important
It is because prostate cancer is very common and but a good proportion of these cancers are considered clinically insignificant
And then there are more aggressive ones which are clinically significant which need to be treated
Our goal is to improve detection of these before they spread So that they can be treated
Xeroradiography is the production of visible image utilizing the charged surface of a photoconductor (amorphous selenium) as the detecting medium, partially dissipating the charge by exposure to X rays to form a latent image and making the latent image visible by xerographic processing.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
7. FDG-PET)
▪ work-up of PUO
▪ sensitive in detecting infection, inflammation &
malignancy
▪ Active TB shows increased uptake
▪ pose as a cancer mimic
7
10. Lymphadenopathy
▪ M/C radiologic manifestation of primary TB
▪ Right paratracheal and hilar lymph nodes
▪ low-attenuation center with peripheral rim enhancement- Rim
sign
▪ D/D:
Nontuberculous mycobacterial infection
Lymphoma
Metastatic carcinoma
10
13. Parenchymal Disease
▪ + Cavitation progressive primary disease
▪ ~ bacterial pneumonia
▪ + lymphadenopathy can be a clue
▪ Slow resolution , 2 years
▪ On CT, the air-space consolidation in primary TB is dense,
homogeneous, and well-defined
13
15. “
“Ghon Lesion”
▪ focus is a granuloma
▪ sequela of primary tuberculosis.
“Ghon Complex”
parenchymal granuloma + hilar LN
“Ranke complex”
late fibrocalcific lesions of the lung and
lymph node evolved from the Ghon complex
15
17. Pleural Effusion
▪ 25% of primary TB in adults
▪ Unilateral
▪ L/C in children
▪ L/C in post primary disease
▪ Tuberculous empyemas typically loculated associated with
pleural thickening and enhancement,
▪ complicated with bronchopleural fistula or extension into the
chest wall (empyema necessitatis) 17
22. Airway Disease
▪ Bronchial wall involvement seen in primary and postprimary tuberculosis
▪ Bronchial stenosis occurs in 10%–40% of patients with active
tuberculosis
Main radiographic features:
▪ segmental or lobar atelectasis
▪ lobar hyperinflation
▪ mucoid impaction
▪ postobstructive pneumonia
22
25. Miliary Tuberculosis
▪ Hematogenous dissemination
▪ Immunocompromised and pediatric patients
▪ Occur in primary or postprimary tuberculosis
▪ Chest radiograph or CT image
diffuse 1–3-mm nodules in a random distribution
25
29. “ 1. Liquefaction of caseous necrosis
2. Formation of cavities
3. Progressive fibrosis and lung destruction
4. Bronchogenic spread.
29
30. Hallmarks of active PPT
▪ Consolidations
▪ alveolar opacities on CXR
▪ clustered nodules
▪ centrilobular nodules on CT
30
31. Consolidation and cavitation
▪ Patchy, poorly marginated consolidation
▪ strong predilection for the apical and posterior
segments of UL & superior segments LL
▪ 3%–6% a noncalcified nodule known tuberculoma
may be predominant manifestation
31
32. Postprimary tuberculosis
▪ Cavitation is a common finding
▪ Several centimeters in largest dimension and
develop thick and irregular walls
▪ Seen within areas of consolidation and may be
multifocal
32
42. Tuberculosis in Immunocompromised Patients
▪ higher risk of developing primary & postprimary
TB
▪ severely immunosuppressed patients with PTB,
CXR may be normal
▪ immune reconstitution inflammatory syndrome
42
48. Tuberculoma
▪ persistent nodules or mass-like lesions
▪ seen in both primary TB and PPT
▪ subcentimetric to 5 cm in diameter
▪ solitary or multiple
▪ satellite lesions around main lesion.
48
49. Pediatric Tuberculosis
▪ M/C form of active TB in children is primary
disease
▪ Hilar & mediastinal lymphadenopathy hallmark of
pediatric TB
▪ 0–3 yrs 50% of cases isolated lymphadenopathy
▪ 5–14 yrs 9% .
▪ Extrinsic compression of adjacent bronchi airway
compression or postobstructive pneumonia 49
50. Latent Tuberculosis
▪ + lab tests in absence of radiographic or clinical
E/O active disease
▪ stable fibronodular changes, including scarring &
nodular opacities in apical & ULZ
▪ Fibronodular change is associated with higher risk
of TB reactivation 50
CXR – part of the initial investigations performed in adults suspected to have TB.
evaluate unexplained cough.
It is the primary modality for diagnosis and follow-up, and may be the only imaging required in sputum-positive cases.
Apicogram/lordotic view (for lung apices) and lateral view are of limited utility
CT is the next investigation in case of equivocal CXR.
USG - Sonography is very useful for pleural effusion detection, characterization, guiding drainage, and follow-up.
Helps in Differentiating minimal effusion from residual thickening
also be used to evaluate associated hepatosplenomegaly, ascites, and abdominal lymphadenopathy
It enables earlier and more accurate diagnosis of pulmonary lesions can be used to differentiate the etiologies of pneumonia.
evaluation of bronchiectasis, cavitation, associated fungal balls, and assessment of necrosis in the LNs, identifying pleural/airway/diaphragmatic pathologies and evaluating visualized bones.
CECT is the investigation of choice for evaluation of mediastinal LNs and also aids in depicting pleural enhancement in empyema.
HRCT detect miliary and centrilobular nodules, ground-glass opacities, and air-trapping.
MRI - MRI is a problem-solving modality
and conventional sequences (T1 and T2W images) should be combined with diffusion-weighted imaging (DWI) and subtracted contrast-enhanced (CE) imaging for optimal evaluation.
Presence of diffusion restriction in the LNs and peripheral enhancement suggest active disease.
It can be used to better evaluate mediastinal nodes and assess disease activity
Since it is free from ionizing radiation, MRI can be employed for follow-up of mediastinal nodal disease in young patients to reduce radiation exposure.
MRI has been proven to be superior to non-contrast CT in the evaluation of mediastinal nodes, pleural abnormalities, and presence of caseation.
fluorodeoxyglucose -positron emission tomography (FDG-PET) plays an important role in the work-up of patients with pyrexia of unknown origin (PUO),
high sensitivity in the detection of infection, inflammation, and malignancy.
Active TB shows increased uptake with high standardized uptake values (SUVs) and may pose as a cancer mimic.
Several different patterns of tuberculous infection have been described,
These include primary MTB, progressive primary MTB, and post primary MTB.
Traditionally, primary TB was considered a disease of childhood, and postprimary tuberculosis was believed to always represent reactivation of latent infection in adults.
these notions to be somewhat inaccurate.
Because of more-effective therapies and the declining prevalence of tuberculosis in developed countries, 23%–34% of adult tuberculosis cases in developed countries are actually primary tuberculosis
With regard to postprimary tuberculosis, evidence suggests that patients in endemic areas are more likely to be infected by a second strain of tuberculosis than to experience reactivation of a previously infected strain
Primary TB is acquired by inhalation of airborne organisms and occurs in patients not previously exposed to Mycobacterium tuberculosis
Primary TB may involve lung parenchyma, LNs, tracheobronchial tree, and pleura. Classically, four entities are described: Gangliopulmonary TB, TB pleuritis, miliary TB, and tracheobronchial TB.
Only the gangliopulmonary form is characteristic of primary TB and the rest may be seen in post-primary disease as well.
Gangliopulmonary TB is characterized by the presence of mediastinal and/or hilar LN enlargement with associated parenchymal abnormalities
Mediastinal and hilar lymphadenopathy is the most common radiologic manifestation of primary tuberculosis
Lymphadenopathy typically demonstrates a low-attenuation center with peripheral rim enhancement on CECT due to central caseous necrosis with peripheral granulomatous inflammatory tissue
The differential diagnosis of necrotic lymphadenopathy includes nontuberculous mycobacterial infection, lymphoma, and metastatic carcinoma
Lymphadenopathy is seen more pediatric cases of primary tuberculosis and than adult cases and typically involves the right paratracheal and hilar lymph nodes.
Within the pediatric population, mediastinal and hilar lymphadenopathy may be the only radiologic finding.
At resolution of lymphadenopathy, calcified normal-sized lymph nodes
Lymphadenopathy from primary tuberculosis in a 6-month-old male infant.
Axial CECT image shows necrotic mediastinal lymphadenopathy (arrow) and a small right-sided pleural effusion.
gross pathologic specimen shows tuberculous lymphadenitis with central caseous necrosis
Parenchymal disease most frequently manifests as consolidation depicted as an area of opacity in a segmental or lobar distribution
Cavitation occurs in a minority of patients with primary tuberculosis and when cavitation occurs, it is known as progressive primary disease
Parenchymal disease often appears similar to bacterial pneumonia, but the presence of lymphadenopathy can be a clue that points toward primary tuberculosis.
Resolution of pulmonary consolidation is generally slow, taking as long as 2 years; and in many cases, residual opacities are seen .
After resolution, residual parenchymal scarring can be seen at sites of prior consolidation in 15%–18% of patients and is referred to as a Ghon focus, or Ghon tubercle
Lymphadenopathy and consolidation in a 6-month-old male infant with primary tuberculosis (same patient as shown in Fig 2).
Frontal chest radiograph shows thickening of the right paratracheal stripe, consistent with lymphadenopathy (arrow), and consolidation (arrowhead) in the right middle and lower lobes
A “Ghon Lesion” or focus is a granuloma in the lung from a previous tuberculous infection. It is a sequela of primary tuberculosis.
When there is a combination of a parenchymal granuloma and an involved hilar lymph node on the same side, the two together are called a “Ghon Complex”.
The combination of late fibrocalcific lesions of the lung and lymph node which evolved from the Ghon complex is referred to as the “Ranke complex
Pleural effusion is seen in approximately 25% of primary tuberculosis cases in adults, with majority being unilateral
is less common in children
also less common in post primary disease
Tuberculous pleural effusions usually result from hypersensitivity to tuberculous protein, rather than frank pleural infection; and therefore, isolation of M tuberculosis from pleural fluid is uncommon.
In PPT, effusion is usually small, loculated, and associated with parenchymal lesions. Since it originates from rupture of a cavity into the pleural space, cultures are usually positive
Tuberculous empyemas are typically loculated and associated with pleural thickening and enhancement If not treated early, tuberculous empyemas may be complicated with bronchopleural fistula or extension into the chest wall (empyema necessitatis)
An air-fluid level within an empyema in the absence of instrumentation is suggestive of a bronchopleural fistula (20). After treatment and healing, residual pleural thickening with calcification can develop, potentially leading to fibrothorax
Multiseptated tuberculous empyema.
US image shows numerous linear echogenic structures in the pleural cavity representing multiple septa, findings that are typically seen in postprimary tuberculosis.
Tuberculous empyema
Axial CECT image shows a loculated right-sided pleural effusion with thickened, enhancing pleura (arrows) as well as infiltration of the extrapleural fat (arrowhead).
Empyema necessitatis in a 35-year-old man with chronic empyema related to tuberculosis. Axial nonenhanced chest CT image shows pleural calcifications (arrowheads), a loculated pleural effusion with marked pleural thickening, and extension into the chest wall (arrows).
Usual clinical feature are painless cystic masses without inflammatory signs on the skin giving the appearance of a cold abscess or a solid tissue mass and can be sometimes mobile. However, it affects the ribs more than the sternum, clavicle and vertebra
Chest computed tomography showing anterior chest wall mass
B: Chest computed tomography findings showing anterior chest wall abscess with pleural involvement and multilocular form.
Bronchial wall involvement may be seen in primary and postprimary tuberculosis, although it is more common in the former
Bronchial stenosis occurs in 10%–40% of patients with active tuberculosis and is due to direct extension from tuberculous lymphadenitis by means of endobronchial or lymphatic dissemination
The main radiographic features of proximal airway involvement are indirect, including segmental or lobar atelectasis, lobar hyperinflation, mucoid impaction, and postobstructive pneumonia.
At CT, airway involvement can manifest as long segment narrowing with irregular wall thickening, luminal obstruction, and extrinsic compression
Calcified peribronchial LNs can erode into or cause distortion of adjacent bronchus (more common on the right side), producing broncholiths. Presence of calcium near an area of lung collapse may be a subtle indicator of broncholithiasis.
Airway involvement with tuberculosis in a 41-year-old woman.
chest radiograph shows right upper lobe collapse (arrow).
(b) Coronal CECT image at the level of the central bronchi shows irregular thickening of the right upper lobe bronchus (arrow), as well as right upper lobe volume loss.
Hematogenous dissemination results in miliary tuberculosis, especially in immunocompromised and pediatric patients.
Miliary disease may occur in primary or postprimary tuberculosis.
In primary tuberculosis, miliary disease often manifests as an acute, severe illness with high mortality
On the chest radiograph or CT image, miliary disease manifests as diffuse 1–3-mm nodules in a random distribution.
Miliary tuberculosis in a 53-year-old man. Axial chest CT image shows numerous micronodules in a random distribution. Note subpleural (arrowhead) and centrilobular (arrow) nodules.
Miliary tuberculosis. (a) Radiograph of the left lung shows diffuse 2–3-mm nodules, findings that are typically seen in miliary tuberculosis
Postprimary tuberculosis is typically thought to result from reactivation of dormant M tuberculosis infection owing to immunosuppression, malnutrition, senility, and debilitation.
but may also result from a second infection with a different strain, especially in endemic areas
The apical and upper lung zone predominance may be related to the relatively reduced lymphatic drainage and increased oxygen tension in these regions, factors that facilitate bacillary replication
PPT is characterized by: Liquefaction of caseous necrosis
Formation of cavities
Progressive fibrosis and lung destruction
Bronchogenic spread.
Initially, there is liquefaction of regions of caseous necrosis, which then communicate with the tracheobronchial tree to form cavities. Coughing may result in bronchogenic spread to other lung segments
Imaging in PPT often shows extensive abnormalities in predisposed locations.
Features of active endobronchial infection - consolidations, alveolar opacities on CXR, clustered nodules, centrilobular nodules on CT - are hallmarks of active PPT.
Patchy, poorly marginated consolidation is an early and consistent feature of postprimary tuberculosis
Consolidation and cavitation have a strong predilection for the apical and posterior segments of the upper lobes as well as the superior segments of the lower lobes in postprimary tuberculosis
Cavitation is also characteristic of PPT, radiographically evident in 40% of cases, and walls may be thin and smooth or thick and nodular. Thick-walled cavities and cavities with surrounding consolidation indicate active infection, while thin-walled cavities suggest healed infection.
Thin-walled cavities may be difficult to differentiate from bullae, cysts, or pneumatoceles.
Air-fluid levels in the cavity occur in 10% of cases and can be due to superimposed bacterial or fungal infection.
Fibro-parenchymal lesions causing distortion of lung parenchyma and cicatricial bronchiectasis develop with healing of active infection.
Tuberculous cavities can rupture into pleural space, resulting in empyema and even bronchopleural fistula. Erosion into the pulmonary artery branches can lead to massive hemoptysis (Rasmussen pseudoaneurysm). Erosion into systemic vessels or pulmonary veins can lead to hematogenous dissemination and miliary TB. Healing of PPT occurs with fibrosis and calcification.
Figure 11a. Postprimary tuberculosis in a 50-year-old man. (a)PA chest radiograph shows patchy airspace opacities (arrows) in the right upper lobe, with a cavitary lesion (arrowheads).
(b) Axial chest CT image shows right upper lobe consolidation (arrows) with associated cavitation (arrowheads).
Figure 12. Postprimary tuberculosis in a 63-year-old man. Coronal chest CT image shows a thick-walled cavitary lesion (arrow) in the right upper lobe.
Figure 14a. Tuberculous cavity in a 32-year-old man with hemoptysis. (a)PA chest radiograph shows two left-sided cavitary lesions (arrows), with an air-fluid level in the larger lesion (arrowhead), and scattered reticulonodular opacities.
(b) Bronchial artery angiographic image shows blush of contrast material around the cavitary lesions (arrow). The patient subsequently underwent bronchial artery embolization.
(c) Phrenic artery angiographic image shows recruitment of additional vasculature (arrow). Embolization of the superior branch of the phrenic artery was also performed.
Rasmussen aneurysm in a 42-year-old man with active postprimary tuberculosis and massive hemoptysis . (a) Contrast-enhanced CT scan at the level of the upper lobes shows, in an area of cavitation, a small rounded bilobed enhancing lesion (arrows) that arises from a branch of the pulmonary artery (arrowhead).
(b) Conventional angiogram shows contrast material filling two aneurysms (arrowheads) in a segmental branch of the right upper lobe pulmonary artery.
Centrilobular Nodules.—Active tuberculosis often communicates with the bronchial tree, which results in endobronchial spread (2).
Histologically, caseous necrosis and granulomatous inflammation fill respiratory bronchioles and alveolar ducts (Fig 15).
This histologic finding manifests radiologically as centrilobular nodules and the tree-in-bud sign (Fig 16).
At CT, centrilobular nodules are seen in approximately 95% of cases of active tuberculosis (2). Unlike cavitary lesions and consolidation, centrilobular nodules may be seen in the lower lobes, distant from the cavitary lesions (16).
Involvement of the airways and pleura is less common in postprimary than in primary tuberculosis but shows similar imaging features.
Figure 16. Airway dissemination of tuberculosis in an 86-year-old man with active tuberculosis (different patient from Fig 15). Axial chest CT image shows centrilobular (arrow) and tree-in-bud (arrowhead) nodules, as well as more confluent areas of consolidation.
Immunocompromised patients are at a higher risk of developing primary and postprimary tuberculosis.
For example, HIV-positive patients with latent tuberculosis infection are 20–30 times more likely to develop active tuberculosis, when compared with HIV-negative patients.
Although most tuberculosis cases in immunocompromised individuals are related to reactivation of latent tuberculosis, the radiologic and clinical manifestations more closely resemble those of primary tuberculosis (ie, with consolidation and lymphadenopathy) (Fig 17a).
In severely immunosuppressed patients with pulmonary tuberculosis, chest radiographs may be normal 10%–40% of the time.
Miliary tuberculosis also occurs at a higher rate in patients with severe immunosuppression.
Treatment of patients with HIV infection by using highly active antiretroviral therapy in patients infected with tuberculosis may result in a paradoxical worsening of pulmonary disease, an entity known as the immune reconstitution inflammatory syndrome.
Figure 17a. Primary tuberculosis in a 39-year-old man with AIDS. (a, b) Magnified contrast-enhanced chest CT images from the same CT examination. (a) Coronal reformatted image (soft-tissue window) at the level of the clavicular heads shows necrotic lymphadenopathy (arrow).
(b) Axial chest CT image (soft-tissue window) at a level just below the carina shows an air collection in the subcarinal region, a finding that represents esophageal perforation with a fistula or sinus tract (arrow) to a necrotic lymph node. (c–e) Sequential magnified axial chest CT images (lung window) at a level just below the carina.
(c) Three weeks after the onset of administration of highly active antiretroviral therapy, the CT image shows multiple centrilobular nodules (arrows)
(d) One week later, diffuse consolidation has developed, representing tuberculosis-associated immune reconstitution inflammatory syndrome. A pneumothorax (arrows) is also depicted.
(e) One month later, after antituberculous treatment, the consolidation has resolved, and the nodules have markedly improved.
Tuberculoma
Tuberculomas are persistent nodules or mass-like lesions which can be seen in both primary TB and PPT. Pulmonary tuberculomas can range in size from being subcentimetric to 5 cm in diameter, and may be solitary or multiple.
They are most often the result of healed primary TB and are usually smooth-walled and sharply defined.
The majority of these lesions remain stable in size and may calcify.
Nodular or diffuse calcification can be seen in 20-30% of tuberculomas.
Cavitation is seen in 10-50% of cases. In 80% of cases, small round opacities (satellite lesions) may be observed in the immediate vicinity of the main lesion.
The manifestation of tuberculosis in pediatric patients differs from that in adult disease. The most common form of active tuberculosis in children is primary disease
The likelihood of developing active tuberculosis decreases with age. Older children and adolescents with active tuberculosis are more likely to show an adult pattern of disease, with postprimary tuberculosis being more common than primary tuberculosis
Hilar and mediastinal lymphadenopathy is the radiologic hallmark of pediatric tuberculosis and may be transiently seen in asymptomatic patients (Fig 2).
Earlier in childhood (ages 0–3 years), nearly 50% of cases can manifest as isolated lymphadenopathy, as compared with only 9% of cases later in childhood (ages 5–14 years) (20).
Extrinsic compression of adjacent bronchi may cause symptoms related to airway compression or postobstructive pneumonia
latent infection refers to positive findings on laboratory screening tests in the absence of radiographic or clinical evidence of active disease
Inactive tuberculosis is characterized by stable fibronodular changes, including scarring (peribronchial fibrosis, bronchiectasis, and architectural distortion) and nodular opacities in the apical and upper lung zones
Fibronodular change is associated with a considerably higher risk of developing tuberculosis reactivation (55).
In contrast, calcified granulomas (Figs 20, 21) and calcified lymph nodes are associated with an extremely low risk of reactivation and are commonly seen in other granulomatous diseases, such as endemic fungal infections and sarcoidosis (55). Healed tuberculous cavities may persist after active disease resolves and can be complicated by hemoptysis, bacterial infection, or mycetoma.
Figure 19a. Fibronodular scarring at the lung apices in a 46-year-old man with previous (inactive) tuberculosis. (a)PA chest radiograph shows upper lobe fibrosis (arrowhead) and volume loss with a residual cavity (arrow).
(b) Axial CT image shows peribronchial fibrosis (arrowhead) and architectural distortion in the lung apices, with a residual cavity (arrow)
Calcified nodules from an old granulomatous infection in a 52-year-old woman with a positive tuberculin skin test before initiation of biological therapy for inflammatory arthritis. PA chest radiograph shows scattered calcified nodules (arrows).
Parenchymal complications
Aspergilloma colonization in pre-existing tuberculous cavities.
Destructive lung changes
Scar carcinoma
Airway complications - tracheobronchial involvement (including broncholithiasis and secondary amyloidosis)
Vascular complications (pseudoaneurysms, hypertrophied bronchial arteries, and systemic collaterals), which present with hemoptysis
Pleural complications (chronic empyema, fibrothorax, bronchopleural fistula, and pneumothorax)
Mediastinal complications: Mediastinal fibrosis, esophageal involvement (in the form of strictures, traction diverticulae, or fistulae), pericarditis, pneumothorax, and spondylodiskitis.
Imaging findings in tuberculous complications.
(A) Axial CT shows thin-walled cavities in both upper lobes and presence of aspergilloma in RT upper lobe cavity.
(B) Axial CECT shows contrast-filled pseudoaneurym (arrow) arising from the superior division of RT pulmonary artery (Rasmussen aneurysm) in the background of fibro-cavitary lesions in both upper lobes.
(C) Axial CECT shows chronic empyema LT side with volume loss and pleural calcifications. \
(D) Coronal CT depicts abnormal communication of pleural space with bronchial tree suggesting a bronchopleural fistula.
(E) Axial CECT shows calcified LN in RT hilum causing post-obstructive atelectasis of RT middle lobe
chest wall tuberculosis occurs by reactivation of latent foci formed during hematogenous or lymphatic dissemination of primary tuberculosis, while others opine that it occurs by direct extension from contiguous lung/pleura.
Rib tuberculosis – patient 8. Frontal radiographs of the ribs (A, B) show an expansile osteolytic lesion with sclerosis involving the posterior end of the left 10th rib (arrows). Lateral skull radiograph (C) of the same patient shows a sharply marginated osteolytic lesion, with marginal sclerosis in the right parietal bone (curved arrow)
Nontuberculous mycobacterial disease in the lungs is most commonly seen with Mycobacterium avium complex—also referred to as Mycobacterium avium-intracellulare complex—and Mycobacterium kansasii
Nontuberculous mycobacterial disease manifests in two major forms: classic (cavitary) and nonclassic (bronchiectatic)
Classic (cavitary) nontuberculous mycobacterial infection can have an appearance and clinical manifestations indistinguishable from those of postprimary tuberculosis;
classic nontuberculous mycobacterial infection is characterized by upper lobe cavitary lesions and centrilobular and tree-in-bud nodules
Upper lobe architectural distortion is often also depicted. Classic nontuberculous mycobacterial infection most commonly affects elderly men with chronic lung disease (typically, emphysema). When compared with tuberculosis, classic nontuberculous mycobacterial infection tends to progress more slowly, and cavities tend to be smaller with thinner walls
Classic nontuberculous mycobacterial infection with M kansasii in a 64-year-old man with emphysema. (a)PA chest radiograph shows patchy consolidation in the right lower lobe and the apices (arrowheads), with possible cavitation. A left-sided basilar pneumothorax (arrow) is incidentally depicted.
(b) Axial chest CT image shows a cavitary lesion (arrowhead), with surrounding centrilobular nodules (arrow), in the left lung.
In contrast, nonclassic (bronchiectatic) nontuberculous mycobacterial infection manifests as chronic bronchiectasis and bronchiolitis with a mid to lower lung zone predominance (74).
This form of nontuberculous mycobacterial infection is most commonly seen in elderly women without predisposing factors.
It is generally not mistaken for tuberculosis, given the mid lung zone distribution and bronchiectasis. However, if there is more bronchiolitis than bronchiectasis, this infection could mimic active postprimary tuberculosis. The lack of upper lung zone predominance should help distinguish these two entities
Classification of Tuberculosis on the Basis of Clinical and Radiologic Findings