Type:
Educational Exhibit
Keywords:
Not applicable, Tropical diseases, Infection, Acute, Diagnostic procedure, CT-High Resolution, CT, Conventional radiography, Thorax, Respiratory system, Lung, Chest
Authors:
J. Andrade1, K. Rajagopal2; 1manipal/IN, 2Manipal, Karnataka/IN
DOI:
10.26044/ecr2020/C-08170
Findings and procedure details
We have compared microbiologically proven cases of tuberculosis and melioidosis in our study. There are various features seen in both of these conditions like consolidation, nodules, cavities which do not play a significant role in differentiating these conditions. However several findings are described below which is predominantly seen in either of these two conditions.
Mediastinal lymphadenopathy
Tuberculosis presents with enlarged mediastinal lymph nodes which show peripheral enhancement and central necrosis. These lymphnodes appear conglomerated(4). In melioidosis, mediastinal lymphnodes are rare(5) (3). However, we found that some of our cases of melioidosis did have lymphadenopathy and these lymphnodes were particularly discrete and showed homogenous enhancement [Fig 1].
Lung abnormalities with concurrent liver and/or splenic abscesses
In most of our cases of melioidosis involving the lower lobes, we observed concurrent splenic and /or liver abscess [Fig 2]. This observation was also noted by Tan et al(6). Solid organ abscesses are not very commonly seen in pulmonary tuberculosis as compared to melioidosis. If seen, they appear as a solitary abscess, whereas miliary abscesses are distributed throughout the liver(7). The abscesses seen in melioidosis are small and clustered together which is not seen in tuberculosis(5) [Fig 3,4].
Post treatment outcome
Tuberculomas post treatment undergo calcification. However in cases of meliodoisis they do not undergo calcification(4) (8) [Fig 5]. Fibrosis is a very common feature of tuberculosis post treatment[Fig 6,7], however it is less pronounced in chronic forms of melioidosis(3).
Pleural effusion
Pleural effusion is a common finding in tuberculosis whereas it is uncommon in melioidosis(3) [Fig 8].
Apical involvement
Apical involvement has been classically described in tubereculosis[Fig7], however in melioidosis has been described as a unusual or rare finding (3)(4). However we have seen that the involvement is quite common which had also been described in some studies(9)[Fig 2].