Adult-onset pulmonary tuberculosis: findings on chest radiographs and CT scans.

Lee, Kyung Soo; Song, Kyoung Seob; Lim, Tae Hwan; Kim, Pyo Nyun; Kim, Il Young; Lee, Byoung Ho

doi:10.2214/ajr.160.4.8456658

Cited by 118 publications

(68 citation statements)

References 5 publications

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“…Post-primary TB can be considered unusual for two reasons. First, it is confined to the basal segments of lower lobes, the right middle lobe or lingular, or the anterior segment of an upper lobe and second, it can manifest as a mass-like density that mimics carcinoma, tuberculoma, or reversible multiple cysts (7)(8)(9). Atypical manifestations of pulmonary TB are common in patients with impaired host immunity (10)(11)(12) and are now considered to be manifestations of primary TB (13,14).…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Tuberculosis Confirmed by Percutaneous Transthoracic Needle Biopsy: Analysis of CT Findings and Review of Correlations with Underlying Lung Disease

et al. 2014

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Pulmonary tuberculosis (TB) is a common lung infection worldwide. Detection of acid-fast bacilli (AFB) in stained sputum typically allows for the diagnosis of pulmonary TB (1-3). However, AFB smear results may be negative, and early diagnosis is often difficult if the process is not discovered via radiological means or by a clinician. Early diagnosis is equally as significant as treatment in reducing the morbidity and mortality associated with pulmonary TB. Transthoracic biopsy and fine-needle aspiration have been demonstrated to be valuable for the diagnosis of tuberculosis (3, 4). Specifically, they are beneficial for patients who have unusual manifestations discovered via radiography. The incidence of pulmonary tuberculosis is higher in patients with chronic interstitial lung disease than in the general population. Furthermore, radiologic findings of TB are frequently atypical (5) and findings of patients with underlying emphysema have not been reported.Our purpose in this study was therefore to assess computed tomography (CT) findings in patients with pulmonary TB, confirmed via percutaneous transthoracic needle biopsy (PTNB) with negative sputum, fiberoptic bronchoscopy and/ or bronchial lavage smear results. An additional aim was to determine the correlation between the CT findings of pulmonary TB and those of co-existing pulmonary diseases.Background: Pulmonary tuberculosis (TB) can produce unusual radiographic findings. Further, negative sputum and bronchoscopic results are common. Early diagnosis is equally as significant as treatment in the reduction of morbidity and mortality associated with pulmonary TB. Aims: The aim of this study was to assess computed tomography (CT) findings of pulmonary TB, confirmed via percutaneous transthoracic needle biopsy (PTNB), and to correlate these findings with coexisting, underlying, lung diseases if present. Study Design: Cross sectional study. Methods: We selected eighty-four patients who were diagnosed with pulmonary TB by way of PTNB. Initially, acid-fast bacilli smear test results from these patients were negative. CT findings were reviewed to detect the presence of parenchymal abnormalities as follows: nodule(s) (<3 cm in diameter), mass (any masses ≥3 cm), daughter nodules, air-space consolidation, cavitation, calcification, lymphadenopathy, mediastinal lymphadenopathy, and associated lung parenchymal disease. Results:The CT findings of pulmonary TB confirmed by PTNB included nodules in 44 of 84 (52.4%) cases; 15 of these 44 cases (34.1%) had daughter nodules. The second most common finding was masses in 24 cases (28.6%), nine of which also had daughter nodules. 16 cases (19.0%) displayed nonsegmental consolidation. Of these 16 cases, four had coexisting usual interstitial pneumonia; four others had emphysema. Two patients with a mass had underlying pneumoconiosis. Conclusion: Nodules or a mass mimicking lung cancer were the most common findings on CT scans in patients with pulmonary TB, confirmed via PTNB. The second most common finding was airspace consolida...

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Section: Discussionmentioning

confidence: 99%

Pulmonary Tuberculosis Confirmed by Percutaneous Transthoracic Needle Biopsy: Analysis of CT Findings and Review of Correlations with Underlying Lung Disease

et al. 2014

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“…Although not specific for TB, apical computed tomographic findings may show a "tree in bud" morphology manifested by centrilobular lesions, nodules, and branching linear densities. 17,18 Among the roughly 15% of patients who present without upper lung field infiltrates, a variety of radiographic findings have been described, including lower lung infiltrates (especially superior segments), nodules, effusions, and hilar adenopathy. Finally, up to 5% of patients with active pulmonary disease may have normal findings on chest radiography.…”

Section: Pulmonary Tbmentioning

confidence: 99%

Current Concepts in the Management of Tuberculosis

Sia

Wieland

2011

Mayo Clinic Proceedings

162

108

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E ffective medical therapy for tuberculosis (TB) has existed for more than half a century, yet TB remains among the most pressing public health issues of our day. Tuberculosis is, in part, a disease of poverty. 1 The fact that it remains the eighth leading cause of death in the world speaks to the challenges facing practitioners and public health officials as they try to control a disease that is so entwined in the cultural and economic fabric of society. Challenges to effective solutions include lack of access to diagnosis and treatment, the frequent coexistence of epidemics of TB and human immunodeficiency virus (HIV), and the Tuberculosis (TB) poses a serious threat to public health throughout the world but disproportionately afflicts low-income nations. Persons in close contact with a patient with active pulmonary TB and those from endemic regions of the world are at highest risk of primary infection, whereas patients with compromised immune systems are at highest risk of reactivation of latent TB infection (LTBI). Tuberculosis can affect any organ system. Clinical manifestations vary accordingly but often include fever, night sweats, and weight loss. Positive results on either a tuberculin skin test or an interferon-γ release assay in the absence of active TB establish a diagnosis of LTBI. A combination of epidemiological, clinical, radiographic, microbiological, and histopathologic features is used to establish the diagnosis of active TB. Patients with suspected active pulmonary TB should submit 3 sputum specimens for acidfast bacilli smears and culture, with nucleic acid amplification testing performed on at least 1 specimen. For patients with LTBI, treatment with isoniazid for 9 months is preferred. Patients with active TB should be treated with multiple agents to achieve bacterial clearance, to reduce the risk of transmission, and to prevent the emergence of drug resistance. Directly observed therapy is recommended for the treatment of active TB. Health care professionals should collaborate, when possible, with local and state public health departments to care for patients with TB. Patients with drug-resistant TB or coinfection with human immunodeficiency virus should be treated in collaboration with TB specialists. Public health measures to prevent the spread of TB include appropriate respiratory isolation of patients with active pulmonary TB, contact investigation, and reduction of the LTBI burden. Proc. 2011;86(4):348-361 AFB = acid-fast bacilli; BCG = bacille Calmette-Guérin; CFP-10 = culture filtrate protein 10; DOT = directly observed therapy; EMB = ethambutol; ESAT-6 = early-secreted antigenic target 6; HIV = human immuno deficiency virus; IFN-γ = interferon-γ; IGRA = IFN-γ release assay; INH = isoniazid; LTBI = latent TBI; MDR-TB = multidrug-resistant TB; NAA = nucleic acid amplification; PZA = pyrazinamide; RIF = rifampin; TB = tuberculosis; TBI = TB infection; TST = tuberculin skin test; XDR-TB = extensively drug-resistant TB Mayo Clin

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“…In childhood, TB lymphadenitis is the most common single manifestation of primary tuberculosis (96% to 100% of cases), generally characterized by conglomerates, localized in multiple sites (mostly in the right paratracheal, hilar and subcarinal areas), with an inhomogeneous CT enhancement pattern and associated with lung infiltrate in 90% of cases [9]. In adults, lymphadenopathy without a parenchymal infiltrate is unusual and very rare and has been observed in patients with acquired immune deficiency syndrome (AIDS) [10]; moreover, TB disease is strongly suggested when a hilar or mediastinal lymph node enlargement is associated with lobar pneumonia.…”

Section: Introductionmentioning

confidence: 99%

Chest tuberculosis with mediastinal asymptomatic lymphadenitis without lung involvement in an immunocompetent patient

Pirina

Spada

Santoru

et al. 2013

J Infect Dev Ctries

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Tuberculosis remains the major cause of morbidity and mortality by a single infectious agent, particularly in developing countries. In recent years, we have witnessed the emergence of uncommon radiographic patterns of chest tuberculosis. Lymphadenitis is the most common extrapulmonary tuberculosis (TB) manifestation which, in developed countries, occurs more frequently in childhood, but also among adult immigrants from endemic countries and in HIV-infected people. Isolated and asymptomatic mediastinal lymphadenitis is uncommon in immunocompetent adults. We report a case of a young adult man from Senegal affected by sovraclavear and mediastinal TB lymphadenitis, which contains some uncommon elements: no compromised immunity, especially no HIV-infection, no lung lesions, no symptoms of infection or of mediastinum involvement, and rapid response to therapy in terms of mass size reduction. Examination of extra-thoracic lymph nodes and the patient's characteristics guided our diagnostic process to suspect TB. Surgical biopsy and subsequent histopathological and microbiological examinations of lymph material, first by Lowestein-Jensen and BACTEC cultures that remain the gold standard of diagnosis, confirmed the diagnosis. Chest X-ray was inconclusive; however, CT played an important role in the diagnostic course and in the management of the patient, particularly in determining disease activity, offering mediastinum and parenchymal details, as well as in identifying typical features of tuberculous lymph nodes and also of active/non active disease. Six months of antimycobacterial regimen is the recommended treatment in TB lymphadenitis of HIV-negative adults.

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Adult-onset pulmonary tuberculosis: findings on chest radiographs and CT scans.

Cited by 118 publications

References 5 publications

Pulmonary Tuberculosis Confirmed by Percutaneous Transthoracic Needle Biopsy: Analysis of CT Findings and Review of Correlations with Underlying Lung Disease

Pulmonary Tuberculosis Confirmed by Percutaneous Transthoracic Needle Biopsy: Analysis of CT Findings and Review of Correlations with Underlying Lung Disease

Current Concepts in the Management of Tuberculosis

Chest tuberculosis with mediastinal asymptomatic lymphadenitis without lung involvement in an immunocompetent patient

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