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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 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
What are the typical features of tuberculosis on a chest x-ray?
Chest x-rays Improvement only if >20,000 films read annually. Nakamura et al. Kekkaku 1970; 45:121
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 • Lower zone • No cavitation • (miliary)
Atypical TB • Female • Diabetes • HIV • Elderly
Extrapulmonary TB • Mediastinal lymph nodes • Pleural effusions • Paraspinal abscess • Spinal disease
Inactive or self-healed tuberculosis • Primary focus/calcified granuloma • Coin lesion • Fibrosis
The normal chest radiograph with a positive M.tb culture • Single isolate or repeated? • Lab contamination – strain typing • CT scan • Treat?
Differential diagnosis • Non-tuberculous mycobacterial disease • Sarcoidosis • Fungal disease
NTMD • Background of COPD • Thicker pleural reaction
Bronchiectasis Tree in bud Nodules
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
