Radiological Features of Mycobacterium tuberculosis · 21 cases due to TB ACUTE PNEUMONIA IN ICU...

1

Guy Richards

Radiological Features of

Mycobacterium tuberculosis

Department of critical care

Charlotte Maxeke Johannesburg Academic Hospital

University of the Witwatersrand,

Johannesburg, South Africa

• phthisis

• consumption

• “A condition of little knobs and swellings”

• King’s evil

• White plague

TUBERCULE BACILLUS

Discovery of Robert Koch,

German bacteriologist (1843-1910)

in the year 1882

Tuberculosis


TUBERCULE BACILLUS


Famous people who had Tuberculosis

Frederick Chopin

Franz Kafka

John Keats

Bronte family

PATHOGENESIS of TUBERCULOSIS

Lymph nodesSwallowedExpelled

Intestine

Calcified

lesion

Stable

Perhaps years

later

ReactivationProgress

Inhaled

organisms

To alveoli

Distant spread

Enlargement &

Local spreadDistant spread

Distant

spread

Primary

complex

Healing

• demonstrate AFB

• positive culture

• skin test

• serology

• PCR

DIAGNOSIS


2

Primary tuberculosis

• lymphadenopathy (big)

• parenchymal disease (small)

• pleural effusion

• atelectasis

• miliary disease

• normal radiograph in ~15%

CLASSIFICATION OF PULMONARY TB



• Areas of greatest lung

ventilation

• Middle lobe

• Lower lobes

• Anterior segment of upper lobes




• hilar and mediastinal lymph-

adenopathy (>2 cm), which

present with a hypodense centre

(caseation) and rim enhancement

• obstructive atelectasis may

occur

• cavitation is uncommon



Harisinghani M G et al. Radiographics 2000;20:449-470

©2000 by Radiological Society of North America



3

Burrill J et al. Radiographics 2007;27:1255-1273




4

Post-primary (reactivation)

• reactivation of previous TB

lesion

• parenchymal disease with

cavitation is common

• pleural involvement

• airway involvement

• other



Post-primary (reactivation)

• apical or posterior segment of

upper lobe

• superior segment of lower

lobes

• usually two or more segments

or bilateral



• early if impaired immunity

• usually reactivated TB

• especially upper lobe

• moderate illness

• often sputum positive

• bronchoscopy if negative

• high communicability

CAVITATORY TB


5





6



• inhalation → controlled• unchecked progressive primary

pneumonia or post-primary TB

• middle / lower lobe• ± adenopathy, cavitation in children

• often fairly ill• sputum usually positive

• high communicability

TB BRONCHPNEUMONIA




Pleural tuberculosis

• can be complication of primary

TB or occur as part of post-

primary TB – pathogenesis

different

• more common in adolescents

and young adults

• commonly unilateral



7



Feldman et al, 1995

280 cases of pneumonia

21 cases due to TB

ACUTE PNEUMONIA IN ICU

Dalmash et al, 1993

113 patients

8% due to TB

Rello et al, 1993

58 patients

11.4% due to TB

Niederman et al, 1993

ATS guidelines


• presentation unusual – the “new” TB

• extrathoracic disease common

• pulmonary lesions -

non cavitatory

associated adenopathy

• invasive procedures for diagnosis

HIV ASSOCIATED TB


9

COMMON COMPLICATIONS OF

TUBERCULOSIS

Early Late

Pneumonia

Empyema

Haemoptysis

Laryngitis

Pneumothorax

Bronchiectasis

Mycetomas in cavities

Colonization if fibrotic lung with non-tuberculosis mycobacterium

Non-respiratory disease (genitourinary, bone tuberculosis


10

Arthur M Walker (1896 – 1955)

I would like to remind those

responsible for the treatment of TB,

that Keats wrote his best poems

while dying of this disease. In my

opinion he would never have done

so under the influence of modern

chemotherapy.


Radiological Features of Mycobacterium tuberculosis · 21 cases due to TB ACUTE PNEUMONIA IN ICU...

Documents

Transcript of Radiological Features of Mycobacterium tuberculosis · 21 cases due to TB ACUTE PNEUMONIA IN ICU...