Pulmonary Tuberculosis Report

8/12/2019 Pulmonary Tuberculosis Report

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Tuberculosis

Is a highly contagious disease caused

by a bacteria known as Mycobacterium

tuberculosis.

Generally affects the lungs, but it alsocan invade other organs of the body, like

the brain, kidneys and lymphatic system.

Characterized by the growth of nodules(tubercles) in the tissues, especially the

lungs


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The Importance of Chest X-Ray

The chest radiograph is not considered as the

gold standard and has limited role in the

diagnosis of smear positive pulmonary

tuberculosis . Its use is recommended for diagnosis of smear

negative pulmonary tuberculosis for difficult

cases.

Repeat X-ray chest if done more than two weeks back or if x-ray chestis not available.

Always ask for previous X- rays.

Always examine the serial x-rays.


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Normal Chest X - Ray


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Location

In majority of cases, pulmonary

tuberculosis manifests itself by

presenting radiological signs

limited to the upper zones.

Chest X- ray can be divided into

three radiological zones.

Upper zone - up to lower margin of 2nd

rib

Mid zone - from lower margin of 2nd rib

to lower

margin of 4th rib

Low er zone - from 4th rib to diaphragm


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PA VIEW

The PA chest-film it is important toexamine all the areas where the lungborders the diaphragm, the heart andother mediastinal structures.

At these borders lung-soft tissueinterfaces are seen resulting in a: Line or stripe - for instance the right para

tracheal stripe. Silhouette - for instance the normal

silhouette of the aortic knob or leftventricle

These lines and silhouettes are usefullocalizers of disease, because they canbe displaced or obscured with loss of thenormal silhouette.

Widening of the paratracheal line (> 2-3mm) may be due to lymphadenopathy,pleural thickening, hemorrhage or fluidoverload and heart failure.

Displacement of the para-aortic line canbe due to elongation of the aorta,aneurysm, dissection and rupture.


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NORMAL APICAL VIEW

Anatomy Demonstrated

Lung apices and the medial ends of

the first 4 ribs

Indications for imaging

To clarify anomaly seen on PA projection:

ex. Interlobular effusion,

Pancoast tumour

superior pulmonary sulcus tumor

an adenocarcinoma of a lung

apex


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Lateral view

The retrosternal space should beradiolucent, since it only containsair. Any radiopacity in this area issuspective of a proces in theanterior mediastinum or upperlobes of the lung.

The contours of the left and rightdiaphragm should be visible.

The right diaphragm should bevisible all the way to the anteriorchest wall (red arrow).

o The left diaphragm can only beseen to a point where it bordersthe heart

o Here the interface is lost, since theheart has the same density as thestructures below the diaphragm.


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PRIMARY PTB

Primary TBpneumonia attackspeople who are: weaker immune

systems

young children elderly are most at risk

those with HIV/AIDS.

This type of TB isuncommon and

attacks the lungs inthe form of pneumoniawith symptoms of highfever and cough.

PA

VIEW

Apical

View

Laterealview


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Primary TB

Unilateral hilar or mediastinal

lymph node enlargement,

particularly in children, and may

be the sole radiographic

manifestation of infection

The radiographic presentation may

include focal air-space opacity or an

isolated pleural effusion.

The parenchymal lesion is often

located in the lower lobes.

Lymphatic spread to regional lymph

nodes may produce adenopathy.

The combination of a calcified

parenchymal opacity (the Ghon

lesion) and ipsilateral hilar

adenopathy is referred to as the

Ranke complex


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POST PRIMARY TB

Reactivation TB or secondary TB

This develops in the posterior segments of the upper

lobes

superior segments of the lowerlobes.

Post-primary infections are far

more likely to cavitate thanprimary infections.

Lobar consolidation, tuberculomaformation and miliary TB are alsorecognized patterns of post-primary TB but are less common.

Tuberculomas account for only5% of cases of post-primary TB

appear as a well defined roundedmass

typically located in the upper lobes

single and measure up to 4 cmin size

APICAL VIEW


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Post Primary TB

Cavitation is an important

radiographic feature of

postprimary infection and usually

indicates active and transmissible

disease

Erosion of a cavitary focus into a

branch of the pulmonary artery

can produce an aneurysm

(Rasmussen aneurysm) and

cause hemoptysis.


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Milliary TB

Miliary TB isdiagnosed when smallgranules appear in thelungs.

Miliary TB maycomplicate eitherprimary or reactivationdisease. It resultsfrom hematogenousdissemination of

tubercle bacilli andproduces diffusebilateral 2- to 3-mmpulmonary nodules


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Miliary TB

micronodular opacities

characteristic of

micronodular (miliary)

interstitial disease.


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On chest radiograph, consisting of

innumerable tiny opacities throughout

the lung .

Cavitary lesions may become

secondarily superinfected by

aspergillus, producing a fungus ball

or mycetoma. the infection may erode

into pulmonary arteries, producing

massive hemoptysis.

Pulmonary Tuberculosis Report

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