This study summarizes the radiographic and CT findings of pulmonary tuberculosis in 25 infants. The most common radiographic findings were air-space consolidation (80%) and mediastinal bulging suggestive of lymphadenopathy (72%). On CT scans, all patients demonstrated air-space consolidation, and frequent findings included masslike consolidation (59%), low attenuation areas within consolidations (41%), cavities within consolidations (29%), and disseminated pulmonary nodules (29%). CT also better depicted lymphadenopathy and associated central necrosis in all patients, as well as frequent airway complications like bronchial narrowing (65%). CT provided additional diagnostic information beyond chest radiography in all 17 patients who received CT scans.
This presentation will help medical students, resident , doctors and nurses to quickly make a review on this interesting topic TB IN CHILDREN. ENJOY IT
Ocular inflammatory disease and ocular tuberculosis in a cohort of patients c...Dr.Samsuddin Khan
Abstract
BACKGROUND:
The prevalence and the patterns of ocular inflammatory disease and ocular tuberculosis (TB) are largely undocumented among Multidrug Resistant TB (MDR-TB) patients co-infected with Human Immunodeficiency Virus (HIV) and on antituberculosis and antiretroviral therapy (ART).
METHODS:
Lilavati Hospital and Research Center and Médecins Sans Frontières (MSF) organized a cross-sectional ophthalmological evaluation ofHIV/MDR-TB co-infected patients followed in an MSF-run HIV-clinic in Mumbai, India, which included measuring visual acuity, and slit lamp and dilated fundus examinations.
RESULTS:
Between February and April 2012, 47 HIV/MDR-TB co-infected patients (including three patients with extensively drug-resistant TB) were evaluated. Sixty-four per cent were male, mean age was 39 years (standard deviation: 8.7) and their median (IQR) CD4 count at the time of evaluation was 264 cells/μL (158-361). Thirteen patients (27%) had detectable levels of HIV viremia (>20 copies/ml). Overall, examination of the anterior segments was normal in 45/47 patients (96%). A dilated fundus examination revealed active ocular inflammatory disease in seven eyes of sevenpatients (15.5%, 95% Confidence Intervals (CI); 5.1-25.8%). 'These included five eyes of five patients (10%) with choroidal tubercles, one eye of one patient (2%) with presumed tubercular chorioretinitis and one eye of one patient (2%) with evidence of presumed active CMV retinitis. Presumed ocular tuberculosis was thus seen in a total of six patients (12.7%, 95% CI; 3.2-22.2%). Two patients who had completed anti-TB treatment had active ocular inflammatory disease, in the form of choroidal tubercles (two eyes of two patients). Inactive scars were seen in three eyes of three patients (6%).Patients with extrapulmonary TB and patients<39 years old were at significantly higher risk of having ocular TB [Risk Ratio: 13.65 (95% CI: 2.4-78.5) and 6.38 (95% CI: 1.05-38.8) respectively].
CONCLUSIONS:
Ocular inflammatory disease, mainly ocular tuberculosis, was common in a cohort of HIV/MDR-TB co-infected patients in Mumbai,India. Ophthalmological examination should be routinely considered in HIV patients diagnosed with or suspected to have MDR-TB, especially in those with extrapulmonary TB.
This presentation will help medical students, resident , doctors and nurses to quickly make a review on this interesting topic TB IN CHILDREN. ENJOY IT
Ocular inflammatory disease and ocular tuberculosis in a cohort of patients c...Dr.Samsuddin Khan
Abstract
BACKGROUND:
The prevalence and the patterns of ocular inflammatory disease and ocular tuberculosis (TB) are largely undocumented among Multidrug Resistant TB (MDR-TB) patients co-infected with Human Immunodeficiency Virus (HIV) and on antituberculosis and antiretroviral therapy (ART).
METHODS:
Lilavati Hospital and Research Center and Médecins Sans Frontières (MSF) organized a cross-sectional ophthalmological evaluation ofHIV/MDR-TB co-infected patients followed in an MSF-run HIV-clinic in Mumbai, India, which included measuring visual acuity, and slit lamp and dilated fundus examinations.
RESULTS:
Between February and April 2012, 47 HIV/MDR-TB co-infected patients (including three patients with extensively drug-resistant TB) were evaluated. Sixty-four per cent were male, mean age was 39 years (standard deviation: 8.7) and their median (IQR) CD4 count at the time of evaluation was 264 cells/μL (158-361). Thirteen patients (27%) had detectable levels of HIV viremia (>20 copies/ml). Overall, examination of the anterior segments was normal in 45/47 patients (96%). A dilated fundus examination revealed active ocular inflammatory disease in seven eyes of sevenpatients (15.5%, 95% Confidence Intervals (CI); 5.1-25.8%). 'These included five eyes of five patients (10%) with choroidal tubercles, one eye of one patient (2%) with presumed tubercular chorioretinitis and one eye of one patient (2%) with evidence of presumed active CMV retinitis. Presumed ocular tuberculosis was thus seen in a total of six patients (12.7%, 95% CI; 3.2-22.2%). Two patients who had completed anti-TB treatment had active ocular inflammatory disease, in the form of choroidal tubercles (two eyes of two patients). Inactive scars were seen in three eyes of three patients (6%).Patients with extrapulmonary TB and patients<39 years old were at significantly higher risk of having ocular TB [Risk Ratio: 13.65 (95% CI: 2.4-78.5) and 6.38 (95% CI: 1.05-38.8) respectively].
CONCLUSIONS:
Ocular inflammatory disease, mainly ocular tuberculosis, was common in a cohort of HIV/MDR-TB co-infected patients in Mumbai,India. Ophthalmological examination should be routinely considered in HIV patients diagnosed with or suspected to have MDR-TB, especially in those with extrapulmonary TB.
Presentation on radiographic representation of pulmonary tuberculosis with specific role of CT scan. Special presentation presented on world TB day at Baqai University Karachi Pakistan
A child can be infected with TB bacteria and not have active disease. The most common symptoms of active TB include fever, cough, weight loss, and chills. TB is diagnosed with a TB skin or blood test, chest X-ray, sputum tests, and possibly other testing or biopsies. TB treatment requires medicines for a few months.
High school year 9 project
Meningitis affect around 3,500 people annually, in UK alone. It is the inflammation of the meninges. Main caused through viral or bacterial pathogens.
Presentation on radiographic representation of pulmonary tuberculosis with specific role of CT scan. Special presentation presented on world TB day at Baqai University Karachi Pakistan
A child can be infected with TB bacteria and not have active disease. The most common symptoms of active TB include fever, cough, weight loss, and chills. TB is diagnosed with a TB skin or blood test, chest X-ray, sputum tests, and possibly other testing or biopsies. TB treatment requires medicines for a few months.
High school year 9 project
Meningitis affect around 3,500 people annually, in UK alone. It is the inflammation of the meninges. Main caused through viral or bacterial pathogens.
Empyema Complicating Pleural Pseudo-Tumour in Human Immunodeficiency Viral Di...semualkaira
Empyema is suppurative infection in the pleural cavity associated with accumulation of pus in the pleural cavity.
It is common among people with immunosuppression.
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: October CasesSean M. Fox
Drs. Breeanna Lorenzen and Travis Barlock are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Lobar Pneumonia
- Necrotizing Pneumonina
- PCP Pneumonia with Pneumatocele
- Pneumothorax
- Pleural Effusion
- Parapneumonic Effusion
- Aortic Transection
- Lung Mass
- ARDS
Abdominal tuberculosis: a surgical perplexityKETAN VAGHOLKAR
Abdominal tuberculosis is one of the most challenging forms of extra pulmonary tuberculosis. The diagnosis of the disease itself poses the greatest challenge due to the variability of presentation. Clinical presentations in various forms with conflicting results on a multitude of haematological, immunological and radiological tests causes a lot of confusion in interpreting and correlating the symptoms to arrive at a diagnosis. This adds to the perplexity in surgical management of this complex disease especially in an era where AIDS has added to the problems. Having arrived at a diagnosis, chemotherapy is the mainstay of treatment. Surgery is indicated when the response to medical therapy is poor or complications supervene. Deciding the optimum procedure is again a major issue. Understanding the pathophysiology therefore is pivotal in making a value decision. The article briefly outlines the approach to this surgical perplexity.
Abdominal Pain as Initial Presentation of Lung Adenocarcinomaasclepiuspdfs
Isolated celiac lymph node metastasis (ICLNM), in general, is not common with a reported incidence of 5–10% for lung adenocarcinoma. Lung adenocarcinoma rarely metastasizes to the celiac lymph node leading to abdominal pain. It is not typical for ICLNM to be the initial presentation of lung adenocarcinoma as well. In this case, a 56-year-old man presented with a 4-week history of persistent periumbilical dull pain. Workup was remarkable for celiac lymph node mass which turned out to be adenocarcinoma with unknown primary cancer. Whole body position emission tomography scan and biopsy of the mass with immunohistochemistry could identify lung adenocarcinoma as the primary cancer. After a well-informed discussion of options for chemotherapy drugs with the patient, the decision was made to pursue bevacizumab combined with chemotherapeutics. He was charged home with abdominal pain relief and outpatient follow-up after short-course of chemotherapy.
Repeated Hemoptysis With Progressive Bronchiectasis: A Case Report of Lady Wi...semualkaira
Bronchiectasis is a type of incurable structural lung disease with
clinical manifestations of chronic cough, expectoration or recurrent hemoptysis, which is often given anti-infection and symptomatic treatment. In this study, a patient suffering from bronchiectasis
with repeated hemoptysis caused by nontuberculous mycobacterium (NTM) was discussed. A 54-year-old female immunocompetent patient was admitted to our hospital due to repeated hemoptysis for 5 years. Computed tomography (CT) scan revealed progressive bronchiectasis in the upper and middle lobes of her right lung.
She subsequently underwent thoracoscopic lobectomy of the right
middle lobe plus segmentectomy of the anterior segment of the
right upper lobe. Postoperative pathological diagnosis was confirmed to be intracellular mycobacterium. In view of her results,
the patient was concluded to have “Lady Windermere syndrome”
and was clinically cured following 15 months of anti-NTM treatment.
Repeated Hemoptysis with Progressive Bronchiectasis: a case report of Lady Wi...komalicarol
Bronchiectasis is a type of incurable structural lung disease with
clinical manifestations of chronic cough, expectoration or recurrent hemoptysis, which is often given anti-infection and symptomatic treatment. In this study, a patient suffering from bronchiectasis
with repeated hemoptysis caused by nontuberculous mycobacterium (NTM) was discussed. A 54-year-old female immunocompetent patient was admitted to our hospital due to repeated hemoptysis for 5 years. Computed tomography (CT) scan revealed progressive bronchiectasis in the upper and middle lobes of her right lung.
She subsequently underwent thoracoscopic lobectomy of the right
middle lobe plus segmentectomy of the anterior segment of the
right upper lobe. Postoperative pathological diagnosis was confirmed to be intracellular mycobacterium. In view of her results,
the patient was concluded to have “Lady Windermere syndrome”
and was clinically cured following 15 months of anti-NTM treatment.
Splenic Tuberculosis – A Rare Presentationasclepiuspdfs
Tuberculosis (TB) is an important health problem in developing countries, mostly seen in immunocompromised patients. Splenic TB is rare and develops as the result of either dissemination of pulmonary or biliary TB, following either ingestion of contaminated food or infected sputum. In developed countries, it is seen in patients with human immunodeficiency virus, but it is associated with significant mortality and morbidity in developing countries. We report a case of splenic TB in a 23-year-old male who presented with fever and left hypochondriac mass. A computerized tomography scan of the abdomen showed splenic enlargement with many hypodense solid to cystic lesions with ill-defined boundary. Exploratory splenectomy was performed and histological examination revealed chronic granulomatous inflammation with numerous epithelioid cells, Langhans giant cells with foci of caseous necrosis consistent with TB. He responded well with four-drug antitubercular treatment.
Presentación sobre la anatomía radiológica normal del niño. Diagnóstico diferencial de las principales lesiones de la columna cervical en el niño pequeño.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. Radiography and CT of Pulmonary Tuberculosis in Infants
Fig. 1—4-month-old girl with pulmonary tuberculosis (patient 15). Masslike
consolidation and bronchial obstruction caused by hilar lymphadenopathy.
A, Chest radiograph shows consolidation in right lower lung zone (asterisk) and
widening of right upper mediastinum (arrows).
B, Enhanced CT scan shows well-defined, well-enhancing, masslike consolidation in
right lower lobe (asterisk). Note low-attenuation lymphadenopathy (arrow)
obstructing bronchus intermedius.
C, CT scan in lower level of image seen in B shows large consolidation in right middle
lobe and right lower lobe. Consolidation is slightly volume expanding. There are
multiple low-attenuation areas (arrows) in consolidation area.
B
A C
biopsy in one. In the remaining 14 patients, more promised, and none were HIV positive. Twenty-one lows: brain (n = 4), liver (n = 2), spleen (n = 3), and
than two of the following three criteria were met patients were vaccinated with BCG (bacille Cal- kidney (n = 1). The median duration of symptoms
[20]: tuberculin skin test (Mantoux test) with five mette-Guérin) at the age of 4 weeks. Physical ex- before the diagnosis of tuberculosis and start of an-
tuberculin units of purified protein derivative that amination of the BCG site and the regional lymph tituberculous medication was 50 days (range, 1–90
resulted in an area of induration of 10 mm or nodes revealed no abnormalities. The Mantoux test days). In four infants (16%), the duration of symp-
greater; ruling out other causes of disease and was performed in all patients and showed positive toms was less than 1 week.
finding that subsequent clinical course of the dis- results in 11 (44%). Seven patients (28%) were ex- Initial chest radiographs were available in all pa-
ease was consistent with tuberculosis (clinical or posed to household members with active pulmo- tients. Follow-up chest radiographs were available
radiologic improvement from antituberculous nary tuberculosis. Symptoms of the patients were in 23 patients. The radiographic follow-up was not
medications); and discovery of at least one family fever (84%), cough (76%), sputum (48%), rhinor- uniform in all patients, and the mean follow-up du-
member with contagious tuberculosis. rhea (36%), and tachypnea (32%). In two patients, ration was 2 years (range, 4 months to 3.5 years).
The study group included 15 boys and 10 girls seizure was an initial manifestation with no signif- Chest CT scans were performed 1–10 days
ranging in age from 2 to 12 months (mean age, 5.9 icant respiratory symptoms. Systemic dissemina- (mean, 4 days) after initial chest radiography for
months). None of the children were immunocom- tion was discovered in eight patients (32%) as fol- one or more of the following reasons: to evaluate
AJR:187, October 2006 1025
3. Kim et al.
CT
On chest CT scans (n = 17), air-space con-
solidation was seen in all 17 patients. Masslike
consolidation was seen in 10 of 17 patients
(59%) (Figs. 1B, 1C, and 3C). The multifocal
low-attenuation areas within the consolidation
were seen in seven patients (41%) (Figs. 1C
and 3C). Cavities within the consolidation
were observed in five patients (29%). In one
patient with a necrotic cavity within the con-
solidation, the necrotic cavity progressed to ex-
tensive bilateral bullous lesions; he was the
only patient who did not survive. Disseminated
pulmonary nodules were revealed in five pa-
tients (29%) (Figs. 3B, 4B, and 5B). In three of
them, disseminated nodules were larger (> 2
mm in diameter) than the usual miliary nodules
of adult tuberculosis and coalesced with each
other (Figs. 3B and 4B). In one patient, cavities
were seen within disseminated nodules
(Fig. 4B). Bronchogenic nodules were found
Fig. 2—6-month-old boy with pulmonary tuberculosis (patient 10). Large cavity within consolidation. in seven patients (41%). In all three patients
Chest radiograph shows large cavity within consolidation in right upper lobe (arrow). Multiple nodules are seen
who had high-resolution CT, centrilobular
in left upper lung field (arrowheads).
nodules or branching linear structures suggest-
ing bronchogenic spread of tuberculosis were
seen (Fig. 6B). Excluding patients with dis-
unusual findings on radiographs such as masslike were observed carefully. When we found a con- seminated nodules in both lungs, pulmonary
lesions or widespread nodules; to find or confirm solidation during the reviewing process, which parenchymal lesions were bilateral in six pa-
lymphadenopathy; and to detect or evaluate com- was enhancing well after contrast agent adminis- tients (50%) and involved the right upper lobe
plications such as airway narrowing with or with- tration, was volume preserving or expanding, and (n = 10), left upper lobe (n = 9), left lower lobe
out atelectasis or emphysema, or pleural or peri- had no air-bronchogram within it, we defined it as (n = 7), right lower lobe (n = 7), and right mid-
cardial tuberculosis. a “masslike consolidation.” dle lobe (n = 5).
CT scans were obtained with third-generation Mediastinal and hilar lymphadenopathies
CT scanners—CT/T 9800 scanner or a HiSpeed Results were observed in all 17 patients. On enhanced
Advantage System (both manufactured by GE Chest Radiography CT, involved lymph nodes showed central low
Healthcare)—at 40–100 mA, 120 kVp, and 1–2 On chest radiography (n = 25), air-space attenuation and peripheral enhancement in all
seconds of scanning time. CT scans were obtained consolidation was the most common paren- patients (Figs. 1B and 6C). The right paratra-
after IV bolus injection of contrast media, with con- chymal lesion, occurring in 20 patients (80%) cheal and subcarinal nodes were the most fre-
tiguous 5–10-mm-thick sections from the lung apex (Fig. 1A). Nodular lesions were found in quently involved (for both, n = 13, 76%). Lym-
to the diaphragm. In three patients, supplementary seven patients (28%), and, among them, ipsi- phadenopathies of right hilar nodes were seen
high-resolution CT scans with 1.5-mm-thick sec- lateral or contralateral air-space consolidation in 10 of 17 patients (59%), left paratracheal
tions were obtained at 5–10-mm intervals with an was seen in five patients (Fig. 2). Dissemi- nodes were found in nine patients (53%), and
edge-enhancing algorithm. nated nodules were found in six patients left hilar nodes were found in seven (41%). In
Three radiologists analyzed the chest radio- (24%) (Figs. 3A, 4A, and 5A), and all of them two patients (12%), calcifications were seen
graphs and CT scans by consensus. In the chest were 4 months old or younger. Cavitations within the enlarged nodes.
radiographs, particular attention was given to the within parenchymal lesions were noted in two Airway complications were also frequent
pattern of pulmonary parenchymal lesions (con- patients (Figs. 2 and 4A). findings on CT scans. Bronchial narrowing
solidation, nodules, and disseminated disease), Mediastinal bulging, suggesting mediasti- was seen in 11 patients (65%) who had adja-
cavities within parenchymal lesions, mediastinal nal or hilar lymphadenopathy, was seen in 18 cent peribronchial lymphadenopathy (Figs. 6C
bulging suggesting lymphadenopathy, and airway patients (72%) (Fig. 1A), but discerning the and 6D). Hyperinflation of the lung with medi-
or pleural complications. On the CT scans, pat- difference between a pulmonary parenchymal astinal lymphadenopathy was seen in eight pa-
terns of pulmonary parenchymal lesions (air- lesion near the hilum and lymphadenopathy tients (47%) (Fig. 6B). Bronchiectasis was
space consolidation, bronchogenic nodules, and was difficult on chest radiographs in many found in one patient.
disseminated nodules); cavities within parenchy- cases. Hyperinflation of the lung (n = 8, 32%) Pleural effusions associated with air-space
mal lesions; mediastinal and hilar lymphadenop- (Fig. 6A), bronchial narrowing (n = 4, 16%) consolidation were seen in five patients (29%),
athy with or without central necrosis; airway (Fig. 6A), and atelectasis (n = 4, 16%) were and it was bilateral in one of them. Pleural effu-
complications; pleural, pericardial, and chest also frequent findings. We found pleural effu- sion was loculated in one patient. Pericardial
wall lesions; and involvement of other organs sion in one patient. thickening was detected in two patients.
1026 AJR:187, October 2006
4. Radiography and CT of Pulmonary Tuberculosis in Infants
Chest radiography and CT findings are (n = 4), confirmation of lymphadenopathy (n = 3). In four patients (24%), a diagnosis
summarized in Table 1. (n = 13), depiction of central necrosis of tuberculosis was suggested only after a
(n = 17) or calcification (n = 2) within the CT scan revealed enlarged lymph nodes with
Additional Information at CT enlarged lymph nodes, detection of bron- central necrosis (Table 1). Extrathoracic in-
In all 17 patients who had a CT scan, we chial stenosis distal to the lobar bronchus volvement (liver [n = 2], spleen [n = 3], and
acquired additional information that could (n = 7), revelation of pleural involvement kidney [n = 1]) of tuberculosis was revealed
not be obtained at chest radiography: revela- (n = 4) and pericardial thickening (n = 2), in the chest CT scan in three patients with
tion of mediastinal lymphadenopathy and detection of extrathoracic lesions disseminated pulmonary nodules (Fig. 3D).
A B
C D
Fig. 3—4-month-old girl with systemic disseminated tuberculosis (patient 12).
A, Chest radiograph shows multiple disseminated nodules in both lungs and consolidation in left lower lung zone (asterisk).
B, Chest CT scan shows disseminated nodules of variable size. Most nodules are larger than 2 mm in diameter.
C, Enhanced CT scan shows consolidation with low-attenuation area (arrows) within it in superior segment of left lower lobe.
D, Numerous low-attenuation nodules are noted in spleen on enhanced CT scan.
AJR:187, October 2006 1027
5. Kim et al.
Fig. 4—4-month-old boy with acute disseminated tuberculosis (patient 14). Cavitary
changes in nodules are seen.
A, Chest radiograph shows numerous nodules in both lungs. Thin-walled cavity
(arrows) is seen in left lower lobe.
B, On chest CT, multiple variable-sized nodules are detected. Cavity formation in
some nodules is noted (arrows).
C, Follow-up chest radiograph obtained 1 year after A and B shows no parenchymal
nodule in either lung.
B
A C
Follow-Up Chest Radiography at initial radiography, was improved in all of phatic vessels (appearing as a linear intersti-
On follow-up chest radiographs (n = 23), these patients at follow-up radiography. The tial pattern on chest radiographs) and results
mediastinal lymphadenopathy and paren- resolution of each radiographic finding after in regional lymphadenopathy. Together, the
chymal lesions had decreased in size in 74% antituberculous medication is summarized primary focus and the enlarged lymph nodes
(17/23) at 1 month after starting the pa- in Table 2. that drain it are called the Ranke complex
tient’s medication (Table 1). Improvement [21–24]. In most cases, the mild parenchymal
of the air-space consolidation preceded re- Discussion lesions and lymphadenopathy resolve sponta-
gression of enlarged nodes, and complete Most pulmonary tuberculosis cases seen in neously. In some cases, however, especially in
resolution of the consolidation occurred infants are primary tuberculosis. The primary young infants, the involved lymph nodes con-
within 6 months (Fig. 4C) in all but the one infection begins with deposition of infected tinue to enlarge [11]. Caseation ne crosis of
patient who developed bullous parenchymal droplets in the lung alveoli, followed by pa- the regional lymph nodes progresses, and
lesions and died due to respiratory failure. renchymal inflammation [11, 21]. The initial the enlarged nodes may compress the regional
In two patients, residual lymphadenopathy inflammation produces localized alveolar bronchi and cause bronchial narrowing, ob-
was identified beyond 1 year (Table 2). New consolidation, which is the primary focus. struction, and emphysema [21, 22]. As dis-
calcifications and decreased lung volume This may, although rarely, progress to involve ease progresses, inflamed nodes can perforate
with focal fibrosis were noted in four pa- a segment or an entire lobe and usually is not neighboring bronchus and discharge caseous
tients and in three patients, respectively, visible on chest radiographs [21, 22]. Infec- material into the bronchial tree, causing bron-
among 18 patients, at 6 months (Fig. 5C). tion then spreads to the central lymph nodes chogenic tuberculosis and focal or lobar
Bronchial narrowing, seen in four patients from the primary focus via draining lym- pneumonia [25, 26].
1028 AJR:187, October 2006
6. Radiography and CT of Pulmonary Tuberculosis in Infants
Fig. 5—3-month-old boy (patient 1) with acute disseminated tuberculosis.
A, Chest radiograph shows multiple disseminated nodules with random distribution
in both lungs.
B, Chest CT scan shows multiple small nodules in both lungs.
C, On follow-up chest radiograph obtained after antituberculosis medication for 1
year, nodules are healed, leaving multiple calcifications. Note multiple calcifications
in spleen (arrows).
A
B C
Mediastinal lymphadenopathy with or monary tuberculosis was a feature of early one patient revealed tuberculous meningitis
without parenchymal abnormality is a radio- childhood, occurring in 49% of cases; only with disseminated tuberculomas (patient 3).
logic hallmark of primary tuberculosis in 9% of patients in later childhood or adoles- In agreement with other studies [16, 17, 24],
childhood [20–24]. In our study, chest radiog- cence showed such findings. However, in our disseminated tuberculosis seemed to be more
raphy showed mediastinal lymphadenopathy study, most patients revealed parenchymal common in infants than older children.
and parenchymal abnormality in 72% and changes in conjunction with lymphadenopa- It is well established that CT scans detect
96% of patients, respectively, and the most thy, and isolated mediastinal lymphadenopa- or confirm lymphadenopathy [12–15, 27].
frequent radiographic finding of pulmonary thy without parenchymal abnormality was Delacourt et al. [14], in their series of 15
parenchymal lesions was consolidation rarely seen. In this study, chest radiography children with tuberculous infection and neg-
(80%). Leung et al. [20], in their series of 191 showed disseminated pulmonary tuberculosis ative chest radiography, found enlarged
children, reported age-related differences in in six patients (24%). All of them were 4 lymph nodes in 60% of patients on chest CT.
the prevalence of parenchymal abnormalities. months of age or younger. Disseminated nod- On enhanced CT scans, tuberculous lym-
Children 0–3 years old had a higher preva- ules were seen in the spleen (n = 2) or liver phadenopathy is seen as enlarged nodes
lence of lymphadenopathy (100%) and a (n = 1) in CT scans of two patients with dis- with low-attenuation centers because of
lower prevalence of parenchymal abnormali- seminated pulmonary tuberculosis (patients 3 caseation necrosis and peripheral rim en-
ties (51%) compared with those 4–15 years and 12). Diffuse enlargement of the liver, hancement representing inflammatory hy-
old. In their series, lymphadenopathy as the spleen, and kidney was noted in one patient pervascularity [13, 27, 28]. In our study, CT
only radiologic manifestation of primary pul- (patient 1) at CT scan. An MRI of the brain in scans delineated lymphadenopathy in four
AJR:187, October 2006 1029
7. Kim et al.
A B
C D
Fig. 6—5-month-old girl (patient 2) with bronchogenic spread of tuberculosis and bronchial stenosis.
A, Chest radiograph shows left hilar bulging (white arrow) and hyperinflation of left lung. Note narrowing of left main bronchus (black arrows).
B, High-resolution CT scan reveals peribronchial infiltrations and peripheral small nodules (arrows) suggesting bronchogenic spread of tuberculosis in left upper lobe.
Hyperinflation of left lung is also noted.
C, CT scan shows narrowing of left main bronchus (black arrows) by enlarged subcarinal lymph nodes (white arrow).
D, Segmental bronchi (white arrow) of left upper lobe are also stenosed by hilar lymph nodes (asterisk). Note enlarged subcarinal lymph node with central low attenuation
(black arrows).
patients who were not suspected to have In our study, air-space consolidation was the frequently found masslike consolidation, which
lymphadenopathy on chest radiographs. most common of parenchymal lesions seen on was well enhancing, volume preserving or ex-
Therefore, CT scans can be helpful in diag- CT scans (100%), which was more common panding, and had no air bronchogram within it.
nosing tuberculosis when findings of chest than that reported in the literature for childhood As mentioned previously, enlarged hilar lymph
radiographs are inconclusive. cases (19% [12] and 49% [13]). In this study, we nodes can compress neighboring regional bron-
1030 AJR:187, October 2006
8. Radiography and CT of Pulmonary Tuberculosis in Infants
TABLE 1: Radiographic and CT Findings of Pulmonary Tuberculosis in 25 Infants
Patients Radiography CT
Parenchymal Lesion Follow-up
Age Mediastinal
No. (mo)/Sex Cons N DN Bulging Others 1 mo 6 mo Cons/Mass Low/Cv N-br DN LNE Others Extrathoracic
1 3/B + + + ↓ Ca++ +/– –/+ + + Br L, Sp, Kd
2 5/G + + H, Br ↓ Ca++ +/– + + H, Pl
3 2/G + + + N/A N/A +/– +/– + + L, Sp
4 5/B + H, A NC N/A +/+ + + (*) H, Br
5 6/B + + + H ↓ ↓V +/– +/+ + + H, Br
6 3/B + + ↓ N/A +/+ + (Ca++) H, Br
7 7/B + + H, Br NC Ca++ +/+ +
8 6/B + + Br NC ↓V +/+ + +
9 4/B + + + H, Br, A ↓ NL +/+ + + H
10 6/B + (Cv) + ↑ Deceased +/– +/+ + + Br, Pl, Pc, Be
11 3/B + + H ↓ NL +/+ –/+ + + (*) H, Br, Pl
12 4/G + + + H ↓ NL +/+ +/– + + H, Br, Pc Sp
13 5/G + + ↓ NL +/+ +/– + (Ca++) H, Br
14 4/B + (Cv) + (Cv) ↓ NL +/– +/+ + (Cv) + (*) Br, Pl
15 4/G + + ↓ ↓V +/+ +/– + Br, Pl
16 4/G + ↓ NL +/– + + (*)
17 12/G + + ↓ Ca++ +/+ + Br
18 12/B + + ↓ NL N/A
19 11/G + + + NC N/A N/A
20 4/B + + A N/A N/A N/A
21 8/G + + A ↓ NL N/A
22 11/B + + ↓ NL N/A
23 3/G + NC NL N/A
24 10/B + ↓ N/A N/A
25 5/B + ↓ NL N/A
Note—Cons = consolidation of air space, N = nodules, DN = disseminated nodules, Mass = masslike consolidation, Low = low attenuation within the consolidation,
Cv = cavity, N-br = bronchogenically spread nodules, LNE = lymph node enlargement with central low attenuation and peripheral enhancement,
Extrathoracic = extrathoracic involvement detected on chest CT scans, B = boy, ↓ = improved pulmonary lesions, Ca++ = calcification, Br = bronchial narrowing, L = liver
involvement, Sp = spleen involvement, Kd = kidney involvement, G = girl, H = hyperinflation of the lung, Pl = pleural effusion or thickening, N/A = not available,
A = atelectasis, NC = no change, ↓ V = decreased lung volume with focal fibrosis, NL = normal, ↑ = aggravated pulmonary lesions, Pc = pericardial effusion or thickening,
Be = bronchiectasis, (*) = lymph node detected only at CT.
chus and cause diffuse inflammation of the Low-attenuation areas within the consoli- [30, 31]. In our study, one patient developed
bronchus [21–23]. The common sequence is hi- dation, representing caseating necrosis, were an extensive bullous lesion.
lar lymphadenopathy, followed by atelectasis also more common in our study, at 41%, than It is well established that CT scans have ad-
and consolidation [11]. The resulting radiographic in that of Kim et al. [13], at 25%. Cavitations vantages over chest radiographs for detecting
findings have been called “collapse-consolida- within consolidations were found in 29% of the brochogenic spread of tuberculosis [32]
tion,” “segmental lesions,” and “epituberculo- patients in our series. Cavitation, indicating and miliary tuberculosis [16–18]. Although
sis” [11, 22]. We believe the same disease high infectivity and high bacillary burden, is bronchogenic nodules were seen in only 29%
process described as collapse-consolidation can the hallmark radiographic findings in postpri- of patients with childhood tuberculosis [13],
explain masslike consolidation on CT mary tuberculosis [21, 29], and it is rare in they were found in 41% of patients in our
scans in our study. Collapse-consolidation is children with primary tuberculosis [11, study. Jamieson and Cremin [17] reviewed
more common in infants than older children and 19–21]. Cavitation was frequently associated high-resolution CT findings of pulmonary tu-
tends to occur within months of the initial infec- with low-attenuation areas within consolida- berculosis in six young children with multiple
tion [11]. Although masslike consolidation was tions (3/5, 60%) in our study. Bullous or cys- disseminated nodules on chest radiographs. In
found in 59% of the patients with consolidation tic lesions in the lung can develop as a rare their study, disseminated nodules varied in size
on CT scans in our series, it was found in only complication. Necrosis and liquefaction in ar- and were even or irregular in distribution. They
15% of patients in the study by Kim et al. [13] eas of pneumonic consolidation are thought suggested using the term “acute disseminated
of childhood tuberculosis. to be the cause of extensive bullous lesions tuberculosis” rather than “miliary tuberculo-
AJR:187, October 2006 1031
9. Kim et al.
TABLE 2: Resolution of Radiographic Findings After Antituberculous Medication it is rare in infants [8, 20]. In pleural tuberculo-
in Patients with Infantile Tuberculosis sis, CT scans are also helpful for determining
Follow-Up Times whether the thickening seen on chest radio-
Initial 1 month 3 months 6 months 1 year graphs represents pleural thickening; chronic
Radiographic Findings (n = 25) (n = 23) (n = 23) (n = 18) (n = 9) loculated effusion, which usually needs decorti-
Consolidation 20 13 7 0 0 cation; or empyema [35]. Table 3 summarizes
the previously reported radiographic and CT
Disseminated nodules 6 4 3 1 0
findings of infant and childhood primary pul-
Mediastinal bulging 18 16 14 5 2
monary tuberculosis compared with our results.
Newly appeared calcification – – – 4 3 Early diagnosis and prompt treatment, con-
Fibrosis and decreased lung volume – – – 3 3 sidering their duration of symptoms (< 1
Note—Data are numbers of patients. week), was possible in only four patients in our
study: three patients who showed definite me-
diastinal bulging on initial chest radiographs
sis” for pediatric patients because miliary nod- childhood tuberculosis (bronchial narrow- and had a positive Mantoux test, and one pa-
ules are defined as tiny nodules less than 2 mm ing in 37% [13] and 29% [27]). CT scans de- tient who showed miliary dissemination of tu-
in diameter, uniform in size, and widespread in tect airway complications better than chest berculosis at chest radiography and had a his-
distribution [33]. On CT scans in our study, radiographs [34]. In seven of 11 patients tory of recent contact with active tuberculosis.
disseminated nodules were seen in 29% of the with bronchial narrowing, we observed Radiographic regression of primary pulmo-
patients. Nodules were larger (> 2 mm) than bronchial narrowing distal to the lobar bron- nary tuberculosis is a slow process. In our
usual miliary nodules and coalesced with each chus on CT scans that was not seen on the study, complete resolution of the consolidation
other in three of five patients. chest radiographs. occurred after a maximum of 6 months of treat-
Infant airways are smaller and more eas- Pleural effusion in primary tuberculosis re- ment, and improvement of the air-space consol-
ily compressed by enlarged hilar lymph sults from pleural infection via direct exten- idation preceded regression of enlarged nodes.
nodes [8, 11, 34]. In our study, bronchial sion—rupture of a subpleural lesion into the Follow-up radiography after antituberculous
narrowing was seen in 65% and hyperinfla- pleural space or spread from caseous lymphad- medication may be performed to be sure that no
tion of lung parenchyma was seen in 47% of enopathy or an adjacent spinal lesion [35]. Pleu- progression or complications have occurred. It
patients on CT scans. These airway compli- ral effusion is not a common feature of primary is not always necessary to achieve normal chest
cations were more common than those of pulmonary tuberculosis in young children, and radiography to discontinue treatment [20, 36].
TABLE 3: Comparison of Radiographic and CT Features of Pulmonary Tuberculosis in Infancy and Childhood:
Literature Review
Schaaf et al. Andronikou et al. Delacourt Leung et al. Bosch-Marcet et al. Uzum et al.
Our Study [8] [27] et al. [14] [20] [15] Kim et al. [13] [12]
Radiologic Studies (n = 25) (n = 29) (n = 100) (n = 15) (n = 191) (n = 32) (n = 41) (n = 48)
Mean age 5.9 mo 65 d 21.5 mo 2y 5.9 y 6y 6y 7.9 y
Radiography
Mediastinal LN 72 89 0 92 63
Consolidation 80 71 0 70
Disseminated nodules 24 26 0
Airway compression 16 41 0
CT
Mediastinal LN 100 92 60 84a 83 73
Ring enhancement 100 67 85
Consolidation 100 49 19b
Masslike consolidation 59 15
Low attenuation 41 25
Cavities 29
Bronchogenic nodules 41 29
Disseminated nodules 29 17
Bronchial narrowing 65 29 37
Note—Numbers in rows under Radiography and CT are all percentages. Cells left blank indicate incidence for this item was not mentioned in the study. LN = lymph node.
a Mediastinal lymph node detected on sonography.
b Parenchymal lesion including consolidation and atelectasis.
1032 AJR:187, October 2006
10. Radiography and CT of Pulmonary Tuberculosis in Infants
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