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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
slide5

Afect

Adenita

Limfangita

Complexul Ranke

slide6
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
slide8
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

slide10
Bronchopneumonia:

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

Associated adenopathies!

Right paratracheal adenopathy

Miliary nodules

slide12
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!

slide14
INFILTRATIVE TUBERCULOSIS
  • PLEURAL TB
  • CAVITARY CHRONIC TUBERCULOSIS
  • MYLIAR TUBERCULOSIS
  • FIBROTIC TUBERCULOSIS
  • TUBERCULOMA
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

slide16
Nodular infiltrate LUL

infiltrative TB RUL

slide18
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

slide20
Segmental infiltrate occupying almost the entire RUL and central tendency to excavation

Massive left pneumonia – etiology TB

slide22
TB PLEURAL EFFUSION

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

Cavern with net wall localized RUL subclavicular

slide25

Cavity grade 2

Between cavern and hilum- drainage bronchia

slide27

Cavity grade 3: 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.

radiological aspects of cavitary tb
Radiological aspects of cavitary TB

Multiple cavities in different stages of evolution

radiological aspects of cavitary tb3
Radiological aspects of cavitary TB

small, multiple aspects in different stages of evolution

complications of cavitary
Complications of cavitary
  • SEROFIBRINOUS PLEURESY
  • PACHIPLEURITIS(PLEURAL ADHESIONS)

(AFTER RESORBTION OF EXUDATE)

  • PLEURAL EMPYEMA

(INFECTION OF EXUDATE)

  • PARTIAL/TOTAL SPONTANEOUS PNEUMOTHORAX
  • BRONCHOGENIC DISEMINATIONS
slide34

Complications of cavitary TB

TB infiltrative lesions of RUL

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

PLEURAL EMPYEMA

slide35

Complications of cavitary TB

  • TB left empyema
  • Infiltrative lesions of right lung
slide36

Complications of cavitary TB

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

slide37

Complications of cavitary TB

  • Bilateral infiltrative lesions
  • RIGHT Pneumothorax
slide38

Complications of cavitary TB

  • Bilateral infiltrative lesions
  • Right hydro-pneumothorax
slide39

Complications of cavitary TB – bronchogenic dissemination

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

slide40

Complications of cavitary TB – bronchogenic dissemination

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

slide41

Complications of 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

postuberculosis fibrosis
POSTUBERCULOSIS FIBROSIS
  • 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-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
  • 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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