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PULMONARY TUBERCULOSIS - RADIOLOGICAL IMAGES -. Dr. Miron Ramona Conf Dr Antigona Trofor. TUBERCULOSIS RADIOLOGY. Pulmonary tuberculosis, especially postprimary disease, nearly always causes abnormalities on chest radiographs.

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Pulmonary tuberculosis radiological images

PULMONARY TUBERCULOSIS- RADIOLOGICAL IMAGES -

Dr. Miron Ramona

Conf Dr Antigona Trofor


Tuberculosis radiology
TUBERCULOSIS RADIOLOGY

  • Pulmonary tuberculosis, especially postprimary disease, nearly always causes abnormalities on chest radiographs.

  • Typically, the disease is parenchymal without nodal enlargement, and it manifests as cavitary lesions.

  • Upper-lobe involvement with cavitation and the absence of lymphadenopathy are helpful in distinguishing postprimary TB from primary TB.

  • In addition to the usually involved pulmonary segments—namely, the apical or posterior segments of the upper lobe or the superior segment of a lower lobe—anterior or basal segments may be involved in as many as 75% of cases.

http://emedicine.medscape.com/article/358735-imaging


Primary tuberculosis radiology
PRIMARY TUBERCULOSIS RADIOLOGY

  • Radiographic screening for active TB in high-risk populations may demonstrate findings consistent with prior and/or current infection.

  • A Ghon focus refers to the initial site of parenchymal involvement at the time of first infection;

  • A Ranke complex is the combination of a Ghon focus and enlarged or calcified lymph nodes;

  • Lymphadenopathy is the radiologic hallmark of primary TB

  • Simon focus are apical nodules that are often calcified and result from hematogenous seeding at the time of initial infection


Primary pulmonary tb

Initial pulmonary lesions

GOHN-RANKE complex

Focus Gohn

Lymphangitis Ranke Complex

Lymphadenopathy

Image in “halter”

PRIMARY PULMONARY TB


Afect

Adenita

Limfangita

Complexul Ranke


Complexul primar Ranke:

GOHN focus (alveolitis)=basal subpleural nodular opacities (most often on right), flou contour

Lymphangitis: radiological expression, in some case appear fibrosis; fine linear opacities that connect the Gohn focus with hilum

Homolateral adenopathy: hilary, interbronchial or paratracheal rounded shape, massive polyciclic aspect,

3

2

1


Complex forms
Complex forms

  • Excavation of caseous alveolitis focus– primary cavern (cavity) transparent thin wall or anfractuous circumscribed, usually localized on the basal or middle lung fields, is accompanied by hilary adenopathy.

  • Voluminous adenophaties: cause ventilation modifications by extrabronchial compression, obstructive emphysema or systematized atelectasis


Vouluminous right hilaradenopathy

Segmental atelectasis in upper right lobe


Complicated forms large cavitary tuberculosis with forms
Complicated formsLarge cavitary tuberculosis with forms:

  • Pneumonia: triangular opacity

    - Can do to excavation

    Is accompanied by adenopathy

Pneumonie TB lob superior drept


  • Bronchopneumonia:

    Macronodulare alveolar opacities, various sizes, unequal distribution, with a tendency to confluence

    Associated adenopathies!

    Right paratracheal adenopathy

    Miliary nodules


  • Miliary tuberculosis

  • Complication of Primary TB

  • Radiological: miliary opacities with diameter < 3 mm, equal in size, homogeneous distribution


Secondary tuberculosis
Secondary tuberculosis

  • Occurs due to reactivation of primary tuberculosis

  • Reactivation of fibrotic lesions from apical territory

  • Reinfection by exogenous contamination

    Can occur after primary infection,

    Radiology- polymorphic semiology!

    Alveolar opacities systematized/nonsystematized;

    Nodular images, cavitary lesions, fibrous lesions, associated lesions

    The affected territories predilection: dorsal and apical segments of upper lobes and apical segments of lower lobes!



1 infiltrative tuberculosis
1. INFILTRATIVE TUBERCULOSIS

  • Lesions of exudative alveolitis

  • Early infiltrates localize subclavicular

  • RADIOLOGY:

    NODULAR INFILTRATE

    ROUND INFILTRATE(ASSMAN)

    NEBULOUS INFILTRATE

    SEGMENTAL INFILTRATE

    Beginning of secondary TB can be: pneumonia, lobar or segmental opacities , bronchopneumoni


Nodular infiltrate LUL

infiltrative TB RUL



Disseminated nodular opacities in both lung fields, most commonly in middle and basal lung fields, moderate intensity, different size, shape removed, the tendency to confluence

TB

Bronchopneumonia


Triangular opacity localized RUL commonly in middle and basal lung fields, moderate intensity, different size, shape removed, the tendency to confluence

TB Pneumonia


Segmental infiltrate occupying almost the entire RUL and central tendency to excavation

Massive left pneumonia – etiology TB


Opacity nonhomogeneous rul
Opacity nonhomogeneous RUL central tendency to excavation

Pneumonia LUL


TB PLEURAL EFFUSION central tendency to excavation

In a patient with pleural exudate, TB is the first etiology to be taken into consideration!


Radiological aspect of cavities caverns depends on the stage in which there are
Radiological aspect of cavities(caverns) depends on the stage in which there are:

Cavity grade 1

Cavity grade 2

Cavity grade 3

Cavity grade 1:

Lucency (darkened area) within the lung parenchyma, with or without irregular margins


Cavity grade 2 wall has its own thin elastic net contour
CAVITY GRADE 2 :wall has its own thin, elastic, net contour stage in which there are:

Cavern with net wall localized RUL subclavicular


Cavity grade 2 stage in which there are:

Between cavern and hilum- drainage bronchia


Cavity grade 2 stage in which there are:


Cavity grade 3 stage in which there are:: old cavity, net shaped, wall fibrosis, cavitary sclerosis may be due to irregular shape, around the cavity disabling injuries. Calcification can exist around a cavity.


Old cavity net contour fibrosis of wall sclerosis around cavity

Cavity grade 3 stage in which there are:

Old cavity, net contour, fibrosis of wall, sclerosis around cavity


Radiological aspects of cavitary tb
Radiological aspects of cavitary TB stage in which there are:

Multiple cavities in different stages of evolution


Radiological aspects of cavitary tb1
Radiological aspects of cavitary TB stage in which there are:


Radiological aspects of cavitary tb2
Radiological aspects of cavitary TB stage in which there are:


Radiological aspects of cavitary tb3
Radiological aspects of cavitary TB stage in which there are:

small, multiple aspects in different stages of evolution


Complications of cavitary
Complications of stage in which there are:cavitary

  • SEROFIBRINOUS PLEURESY

  • PACHIPLEURITIS(PLEURAL ADHESIONS)

    (AFTER RESORBTION OF EXUDATE)

  • PLEURAL EMPYEMA

    (INFECTION OF EXUDATE)

  • PARTIAL/TOTAL SPONTANEOUS PNEUMOTHORAX

  • BRONCHOGENIC DISEMINATIONS


Complications of stage in which there are:cavitary TB

TB infiltrative lesions of RUL

Mixed image horizontal line of the air-fluid level right hemithorax

PLEURAL EMPYEMA


Complications of stage in which there are:cavitary TB

  • TB left empyema

  • Infiltrative lesions of right lung


Complications of stage in which there are:cavitary TB

Pulmonary hiperlucency design collapsed lung to hilum (right lung field), large infiltrative lesions (left lung field)


Complications of stage in which there are:cavitary TB

  • Bilateral infiltrative lesions

  • RIGHT Pneumothorax


Complications of stage in which there are:cavitary TB

  • Bilateral infiltrative lesions

  • Right hydro-pneumothorax


Complications of stage in which there are:cavitary TB – bronchogenic dissemination

Micronodular opacities, diffuse shape, vaguely defined, tendency to confluence to delimit small areas excavated


Complications of stage in which there are:cavitary TB – bronchogenic dissemination

Bronchogenic dissemination from RUL to LIL(disemination type “Cardis”)


Complications of stage in which there are:cavitary TB – bronchogenic dissemination

Hiperlucency excluding left lung, with attraction of trachea to the left, ascension compensatory of the diaphragm, hyperinflation of contralateral lung, right lung shows extensive infiltrative lesions and a cavity to the apex

Images - multi-drug resistance TB


Miliary tb miliary nodules distributed homogenous in both lung fields
Miliary TB - stage in which there are:miliary nodules distributed homogenous in both lung fields


Postuberculosis fibrosis
POSTUBERCULOSIS FIBROSIS stage in which there are:

  • Retraction of LUL with fibrous lesions extended to right lung

  • Basal left pachipleuritis


Fibrothorax the final process of sclerosis that interested entirely the lung
FIBROTHORAX stage in which there are:-The final process of sclerosis that interested entirely the lung

  • Sclerosis of right lung

  • Retraction of left hemithorax

  • Nodular lesions of left lung


5 tuberculoma
5. Tuberculoma stage in which there are:

  • Radiological: round, oval, encapsulated opacity, homogeneous or heterogeneous structure, net shape, can be solitary or multiple lesions

  • Seriate radiographs show stability in time!


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