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TB PNEUMONIA

Chest X-ray Interpretation in TB/HIV Settings Training courseMinistry of Health and Social Welfare

French-Cambodian AssociationICAP Columbia UniversityPharmAccess Foundation

Tanzania, 2009

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Common adult TB

Basic radiological images:

Nodule

Infiltrate

Cavity

Pneumonia

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TB pneumonia (1)

This is an alveolar image: non-homogenous,not clear margins, except if contact withfissure and with air bronchogram

The association with other tuberculouslesions is very frequent: adenopathies,nodules and infiltrates, especially in PLHIV

The lesions are often bilateral butasymmetrical

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TB pneumonia (2)

AFB is often positive in sputum, because theselesions are very rich in TB bacilli.

The spontaneous evolution is development of

cavitation and destruction of the lung tissue,retraction and fibrosis: important sequela iftreatment is too late.

TB pneumonia is frequent among PLHIV. In thiscases the pneumonia is frequently in the inferiorlobes as is in the superior lobes. it is oftenassociated with adenopathies. The cavitation isinfrequent in cases of severe immunosuppression.

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woman 30 years old HIV+ worsening condition cough weight loss

fever dyspnea CD4: 65 AFB positive

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Male, 30 years old. Dyspnea, fever, cough and weight loss over 2 months

major fissure

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Male, 80 years old, worsening condition, dyspnea, nonproductive cough, sputum not available

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Tuberculous pneumonia AFB +

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HIV+

CD4< 100

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Male 30 years old HIV +

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Male 37 years old

HIV + CD4 80/mm3 Weight loss Dyspnea Headache Seizures Fever Sputum not available

Widen mediastinum

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Young man, no pathological clinical history:

acute onset of fever, chills, thoracic pain

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Young woman, 39-40C fever for 48h,non-productive cough and right thoracic pain

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PLHIV with AFB sputum negative,severe dyspnoea, normal or subnormal auscultation

and diffuse bilateral infiltrates

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Conclusion 1

TB frequently presents radiologically as pneumonia

PTB lesions are often bilateral and associated withnodules, adenopathies, cavities

If TB penumonia, AFB is often positive, but do not neglectcauses of false negative:

salivary sputum

patient too weak for reliable sputum laboratory error

treatment started before sampling

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Conclusions 2

TB pneumoniae is frequent among PLHIV:all the lobes can be affected (particularly theinferior lobes) and are often associated withbulky adenopathies. In cases of severe

immunodepression, cavitation is rare Differential diagnosis with the other

infectious pneumoniae is only possible withthe history-taking and clinical examination,

which must always be associated with theanalysis of the CXR.

Anytime you are not sure: make clinical,radiological and sputum/lab follow up

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End of the module