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Chest radiographs and TB. Graham Bothamley Jean-Paul Zellweger. Plan of session. The typical chest x-ray of TB Atypical chest x-rays Extrapulmonary TB on the chest x-ray Inactive tuberculosis The normal chest x-ray with C+PTB Differential diagnoses.

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chest radiographs and tb

Chest radiographs and TB

Graham Bothamley

Jean-Paul Zellweger

plan of session
Plan of session
  • The typical chest x-ray of TB
  • Atypical chest x-rays
  • Extrapulmonary TB on the chest x-ray
  • Inactive tuberculosis
  • The normal chest x-ray with C+PTB
  • Differential diagnoses
chest x rays
Chest x-rays

Improvement only if >20,000 films read annually. Nakamura et al. Kekkaku 1970; 45:121

conclusions from mass x ray surveys
Conclusions from mass x-ray surveys
  • Sudden, symptomatic onset as common as insidious onset
  • Disease extent unrelated to duration (extensive S+PTB within first 3-6 m)
  • Cavitation is not a late occurrence – its frequency is nearly the same at all temporal stages of the disease

Toman. Case finding and chemotherapy. WHO, Geneva, 1979

atypical tb
Atypical TB
  • Lower zone
  • No cavitation
  • (miliary)
atypical tb8
Atypical TB
  • Female
  • Diabetes
  • HIV
  • Elderly
extrapulmonary tb
Extrapulmonary TB
  • Mediastinal lymph nodes
  • Pleural effusions
  • Paraspinal abscess
  • Spinal disease
inactive or self healed tuberculosis
Inactive or self-healed tuberculosis
  • Primary focus/calcified granuloma
  • Coin lesion
  • Fibrosis
the normal chest radiograph with a positive m tb culture
The normal chest radiograph with a positive M.tb culture
  • Single isolate or repeated?
  • Lab contamination – strain typing
  • CT scan
  • Treat?
differential diagnosis
Differential diagnosis
  • Non-tuberculous mycobacterial disease
  • Sarcoidosis
  • Fungal disease
slide20
NTMD
  • Background of COPD
  • Thicker pleural reaction
slide26

Bronchiectasis

Tree in bud

Nodules

the quiz
The Quiz

Estimate the probability of the diagnosis of tuberculosis and indicate whether you think the person will be sputum smear-positive

  • Read the histories and estimate a prior probability of TB
  • Look at the CXRs again – in a different order this time and again estimate the probability of TB and whether the sputum smear will be positive