Learning objectives
To review and correctly recognize the signs of pulmonary tuberculosis (TB) on chest X-ray (CXR) and CT.
Background
Around a quarter of the world population is infected with M. Tuberculosis [1].
Usually, CXR is the first-line exam for patients with respiratory symptoms. CXR for TB detection is relevant in both emergency and screening settings [2].
Radiograms can show almost the same findings of CT and, even if around 15% of primary TB cases may present negative CXR [3], sometimes this diagnosis is overlooked. Active pulmonary tuberculosis needs to be addressed urgently to avoid further transmission, complications and sequelae.
Findings and procedure details
Pulmonary tuberculosis is commonly divided into:
1) Primary (children and immunocompromised patients, 23%–34% of adult cases [4]) which may present with:
Consolidations
Lymphadenopathy
Pleural effusion
Miliary spread
2)Post-primary (adolescence and adulthood[4]) which may present with:
Consolidations
Cavitations
Pleural effusion
Centrilobular nodules
Tuberculosis can manifest as an active or inactive form (Fig.1).
Active forms can occur as primary or post-primary tuberculosis, while the latent form refers to the asymptomatic primitive infection.
Tuberculosis can lead to sequelae that can be seen on CXR.
Stability of radiographic findings...
Conclusion
The diagnosis of tuberculosis on CXR may be challenging.
A prompt diagnosis requires attention to all possible subtle signs connected to tuberculosis on CXR and CT.
Personal information and conflict of interest
References
Global tuberculosis report 2019 for the Global TB Programme, World Health Organization, Geneva, Switzerland, Oct.2019 https://www.who.int/tb/publications/global_report/en/
Miller, C., Lonnroth, K., Sotgiu, G., et al. The long and winding road of chest radiography for tuberculosis detection. European Respiratory Journal 49 (2017).
Burrill J,Christopher J.W.,Bain G., et al. Tuberculosis: A Radiologic Review, RadioGraphics200727:5,1255-1273
Harisinghani MG, McLoud TC, Shepard J-AO, et al. Tuberculosis from Head to Toe. RadioGraphics. 2000;20(2):449-470.
Nachiappan AC, Rahbar K, Shi X, et al. Pulmonary Tuberculosis: Role of Radiology in Diagnosis and Management. RadioGraphics. 2017;37(1):52-72....