Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At...

72
Basic Chest Radiology for the TB Clinician Adapted from the ISTC TB Training Modules 2009 PRESENTATION MATERIALS

Transcript of Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At...

Page 1: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

Basic Chest Radiology for the TB Clinician

Adapted from the ISTC TB Training Modules 2009

PRESENTATION MATERIALS

Page 2: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Basic Radiology for the TB Clinician

Objectives: At the end of this presentation, participants will be able to:

Analyze the technical quality of chest X-rays (CXRs) using simple parameters

Identify basic normal CXR anatomy on both frontal and lateral views

Recognize radiographic patterns of disease and describe using appropriate terminology

Describe both the typical and atypical patterns of radiographic presentation for pulmonary tuberculosis

2

Page 3: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Basic Radiology for the TB Clinician (2)

Overview:

Technical aspects of chest radiography

Systematic approach to reading CXR

Basic CXR anatomy

Patterns of disease

Radiographic manifestations of tuberculosis (TB)

3

Page 4: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Chest Radiography: Basic Principles

Blackest

air

fat

soft tissue

calcium

bone

X-ray contrast

metal

Whitest

Maximum X-RayTransmission(least dense tissue)

Maximum X-Ray Absorption(densest tissue)

X-ray photon: Absorbed / scattered / transmitted X-ray absorption depends on:

• Beam energy (constant)• Tissue density

4

Page 5: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Differential X-Ray Absorption

Why we see what we see:

Structures are visible on a radiograph because of the juxtaposition of two different densities creating an interface

Silhouette Sign

Loss of an expected interface

No boundary can be seen between two structures because they now are similar in density

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 5

Page 6: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Silhouette Sign: RLL PneumoniaSilhouette Sign: RLL Pneumonia

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 6

Page 7: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Silhouette Sign: RLL PneumoniaSilhouette Sign: RLL Pneumonia

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 6

Page 8: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Assess CXR Technical Quality

Inspiratory effort

• 9-10 posterior ribs

Penetration

• thoracic intervertebral disc space just visible

Positioning / rotation

• medial clavicle heads equidistant from spinous process

7

Page 9: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009Image credit: Curry International Tuberculosis Center, University of California, San Francisco 8

Page 10: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

10

12

3

4

5

6

7

8

9

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 8

Page 11: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

10

12

3

4

5

6

7

8

9

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 8

Page 12: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

10

12

3

4

5

6

7

8

9

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 8

Page 13: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Inspiratory Effort

Low Lung Volumes Full Inspiration

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 9

Page 14: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Overexposure Proper Exposure

Exposure

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 10

Page 15: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Overexposure Proper Exposure

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 11

Page 16: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Rotated (Oblique)Image credit: Curry International Tuberculosis Center, University of California, San Francisco 12

Page 17: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Basic Radiology for the TB Clinician

A systematic approach to reading a CXR

Image Credit: Lung Health Image Library/Gary Hampton 13

Page 18: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Approach to Reading a CXR

Be Systematic

Lungs

Pleural surfaces

Cardiomediastinal contours

Bones and soft tissues

Abdomen

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 14

Page 19: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Worth a Second Look

Apices

Retrocardiac areas (left and right)

Hilar regions

Below diaphragm

15

Page 20: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Apical TBImage credit: Curry International Tuberculosis Center, University of California, San Francisco 16

Page 21: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009Image credit: Curry International Tuberculosis Center, University of California, San Francisco

Apical TB (2)17

Page 22: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Left Retrocardiac Opacity

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 18

Page 23: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Nodule Behind Diaphragm

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 19

Page 24: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Basic Radiology for the TB Clinician

Basic CXR Anatomy

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 20

Page 25: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Basic CXR Anatomy

Frontal and Lateral Views

Heart

Aorta

Pulmonary arteries

Airways

Image Credit: Lung Health Image Library/Pierre Virot21

Page 26: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009Image credit: Curry International Tuberculosis Center, University of California, San Francisco 22

Page 27: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Aortic arch

Right pulmonary artery

Left pulmonary artery

Trachea & bronchi

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 23

Page 28: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Aortic arch

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 23

Page 29: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Aortic arch

Right pulmonary artery

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 23

Page 30: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Aortic arch

Right pulmonary artery

Left pulmonary artery

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 23

Page 31: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Aortic arch

Right pulmonary artery

Left pulmonary artery

Trachea & bronchi

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 23

Page 32: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Basic Radiology for the TB Clinician

Patterns of disease

24

Page 33: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Chest Radiographic Patterns of Disease

Consolidation / air-space opacity

Interstitial opacity

Nodules and masses

Lymphadenopathy

Cysts and cavities

Pleural abnormalities

25

Page 34: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Consolidation / Air-Space Opacity

Caused by filling of alveoli with fluid, pus, blood, cells (tumor), etc.

May be diffuse, or isolated to segments or lobes of the lung

May be associated with air bronchograms (air-filled bronchus surrounded by opacified lung)

26

Page 35: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Pneumonia

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 27

Page 36: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Interstitial Opacity

Disease localized to pulmonary interstitium, i.e., the alveolar septae and connective tissues that support the alveoli

Hallmarks:• Lines and/or reticulation• Small, well-defined nodules

Miliary pattern

DDX: Pulmonary edema, interstitial lung diseases (e.g., idiopathic pulmonary fibrosis), sarcoidosis, infection, tumor (lymphangitic spread), etc.

28

Page 37: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Interstitial Opacity: Lines

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 29

Page 38: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Interstitial Opacity: Lines

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 29

Page 39: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Interstitial Opacity: Lines & Reticulation

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 30

Page 40: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Nodules and Masses

Nodule: discrete pulmonary lesion, sharply defined, nearly circular opacity 0.2 - 3 cm

Mass: larger than 3 cm

Describe with qualifiers:

• Single or multiple

• Size

• Border characteristics

• Presence or absence of calcification

• Location

31

Page 41: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Well-Defined Calcification

Ill-Defined Mass

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 32

Page 42: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Lymphadenopathy (LAN)

Non-specific terms:

• Mediastinal widening

• Hilar prominence

Specific patterns:

• Particular station enlargement (location)

Important to know what “normal” should look like in order to recognize “abnormal”

33

Page 43: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009Image credit: Curry International Tuberculosis Center, University of California, San Francisco 34

Page 44: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009Image credit: Curry International Tuberculosis Center, University of California, San Francisco 34

Page 45: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009Image credit: Curry International Tuberculosis Center, University of California, San Francisco 34

Page 46: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009Image credit: Curry International Tuberculosis Center, University of California, San Francisco 34

Page 47: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009Image credit: Curry International Tuberculosis Center, University of California, San Francisco 34

Page 48: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Infrahilar window (right hilar and/or subcarinal)

Left hilar

Subcarinal

Lymphadenopathy

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 35

Page 49: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Infrahilar window (right hilar and/or subcarinal)

Lymphadenopathy

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 35

Page 50: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Left hilar

Lymphadenopathy

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 35

Page 51: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Subcarinal

Lymphadenopathy

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 35

Page 52: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Right Paratracheal & Bilateral LAN

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 36

Page 53: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Right Hilar LAN

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 37

Page 54: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Right Hilar LAN

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 38

Page 55: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

*

Subcarinal LAN

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 39

Page 56: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

AP Window LAN

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 40

Page 57: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Cysts & Cavities

Abnormal pulmonary parenchymal spaces (“holes”), filled with air and/or fluid, with a definable wall (>1 mm)

• Cyst: congenital or acquired

• Cavity: caused by tissue necrosis, (inflammatory and/or neoplastic)

Characterize:

• Wall thickness at thickest portion

• Inner lining

• Presence / absence of air / fluid level

• Number and location

41

Page 58: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

TB or Not TB? Cysts and Cavities

Are there radiographic features that suggest benign vs. malignant diagnoses?

A

“45 year old man from China with cough, weight loss”

C

D

B

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 42

Page 59: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

TB or Not TB? Cysts and Cavities (2)

Are there radiographic features that suggest benign vs. malignant diagnoses?

Benign cysts: uniform wall thickness, 1mm, smooth inner lining (e.g., PCP)

Benign cavities: max. wall thickness 4 mm, minimally irregular inner lining (e.g., TB)

Malignant cavities: max. wall thickness 16 mm, irregular inner lining

43

Page 60: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Pleural Disease: Basic Patterns

Effusion

• Angle blunting to massive

Thickening

Mass

Air

Calcification

44

Page 61: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Pleural Effusion

45

Page 62: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Post-TB Pleural Calcification

46

Page 63: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Plombage with Lucite balls

47

Page 64: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Basic Radiology for the TB Clinician

Radiographic Manifestations of TB

48

Page 65: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Can this be TB?

“Typical Pattern”:Post-primary TB

Distribution• Apical / posterior segments of

upper lobes

• Superior segments of lower lobes

• Isolated anterior segment involvement unusual for M.tb(think M. avium complex)

49

Page 66: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

“Typical pattern”: Post-Primary TB

Patterns of disease

• Air-space consolidation

• Cavitation, cavitary nodule

• Endobronchial spread

• Miliary

• Bronchostenosis

• Tuberculoma

• Pleural effusions (empyema most likely in post-primary disease)

50

Page 67: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Can this be TB?

“Atypical pattern”: Primary TB

Distribution : any lobe involved (slight lower lobe predominance)

Air-space consolidation

Cavitation is uncommon (<10%)

Adenopathy is common (esp. children and HIV), predilection for right side

Miliary pattern

Pleural effusions

51

Page 68: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Can this be TB? Miliary TB

52

Page 69: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Radiographic Patterns: Pulmonary TB

TB Pattern“Typical”

(Post-Primary)“Atypical”(Primary)

Infiltrate 85% upper

Upper : Lower 60 : 40

Usually upper in children

Cavitation Common Uncommon

Adenopathy UncommonChildren common

Adults ~30%Unilateral > bilateral

Effusion May be present May be present

53

Page 70: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

CXR Pattern: Early vs. Advanced HIV

Early HIV (CD4>200)

Advanced HIV (CD4<200)

Pattern“Typical”

(Post-primary)“Atypical”(Primary)

Infiltrate Upper lobesLower lobes, multiple

sites, or miliary

Cavitation Common Uncommon

Adenopathy Uncommon Common

Effusion Uncommon More common

54

Page 71: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Can this be TB?

“Old / Healed” TB Ca++ granuloma–Ghon lesion

Ca++ granuloma and hilar node calcification–Ranke complex

Apical pleural thickening

Fibrosis and volume loss

55

Page 72: Basic Chest Radiology for the TB Clinician · Basic Radiology for the TB Clinician Objectives: At the end of this presentation, participants will be able to: Analyze the technical

ISTC TB Training Modules 2009

Basic Radiology for the TB Clinician

Summary: Remember: Technical quality

can significantly impact your CXR interpretation

Develop a systematic approach (and use it every time!)

Practice identifying normalCXR anatomy

Important to characterize and describe lesions—this can help with your differential diagnosis

Whether typical or atypical

TB can always fool you!

56