6. CECT show tuberculous nodes
that show central areas of low
attenuation suggestive of
caseous necrosis and peripheral
rim enhancement
7.
8. GHON FOCUS
• Ghon focus may be visualized on
the chest radiograph as an airspace
opacity
9. GHON LESION/FOCUS
• Small tan-yellow subpleural
granuloma in the mid-lung field on
the right.
• Over time, the granulomas decrease
in size and can calcify, leaving a focal
calcified spot on a chest radiograph
that suggests remote granulomatous
disease.
10. GHON COMPLEX
• typical of primary
tuberculosis in a child
• Parenchymal involvement is
more in adults.
14. PLEURAL EFFUSION IN TB
Pleural effusion is usually
unilateral and due to
subpleural infection.
Pleural effusions are more
common in adults with
primary tuberculosis (40%).
15. shows a right upper lobe airspace
opacity adjacent to the trachea. In
addition, there is
elevation of the minor fissure (arrows),
(ATELECTASIS)
VOLUME LOSS
16. POST-PRIMARY
TUBERCULOSIS
• focal or patchy heterogeneous
consolidation involving the
apicoposterior segments of the
upper lobes and the superior
segments of the lower lobes
17. • lateral view of the same
patient, the typical location of
the apicoposterior segment
18. •Predilection for upper
lobes
•Lack of lymphadenopathy
•Propensity for cavitation
Post-primary
tuberculosis
distinguishing
features
POST-PRIMARY TUBERCULOSIS/REACTIVATION
TUBERCULOSIS
19. • The predilection for the upper lobes is thought to be due to
decreased lymph flow in the upper regions of the lung.
• An alternative explanation is the presence of higher oxygen
tension in that region.
20. CAVITATION
• Xray showing cavitatory
consolidation in right upper lung
zone and multiple ill-defined
nodules in both lungs
21. Cavitation and tree in bud sign is indicative of an active
disease process and usually heals as a linear or fibrotic
lesion.
22. MILIARY
TUBERCULOSIS
Miliary TB refers to
widespread
dissemination of TB by
hematogenous spread.
Seen more frequently in
reactivation TB
Seen in pts with
Location
23. The characteristic
radiographic and high
resolution CT findings
consist of innumerable,
1- to 3-mm diameter
nodules randomly
distributed throughout
both lungs
31. spherical nodule or a mass
separated by a crescent-
shaped area of decreased
opacity or air from the
adjacent cavity wall
32.
33. BRONCHIECTASIS
Bronchiectasis is seen in 30%–60% of patients with active postprimary
tuberculosis and in 71%–86% of patients with inactive disease at high-
resolution CT
35. This case demonstrates
a left pleural effusion with air-fluid
levels consistent with a
hydropneumothorax caused by the
bronchopleural fistula.
Diagnosis of hydropneumothorax is
based on the presence of a pleural
effusion accompanied by an air-fluid
level within the pleural space.
TUBERCULOUS EMPYEMA
44. BRONCHOGENIC CARCINOMA
• Tuberculosis may predispose to the development of
bronchogenic carcinoma by local mechanisms (scar cancer)
• Carcinoma may lead to reactivation of TB, both by eroding into
an encapsulated focus and by affecting the patient’s immunity.
49. • As the CD4 lymphocyte count declines, the radiographic
findings look more like those seen in primary disease.
• The radiographic opacities may be in the lower lung zones
and multilobar in nature.
• Lymphadenopathy is more common.
TUBERCULOSIS AND HIV
57. TUBERCULOSIS IN INDIA
• India is responsible for 1/3rd of the global cases of
tuberculosis
• 1.8 million new cases of tuberculosis are reported every
year
60. GANGLIOPULMONARY T.B
• Very specific to primary t.b
mediastinal and/or hilar
adenopathies and less
conspicuous parenchymal
abnormalities.
• preferential occurrence in
children, it has been designated
as “childhood”-type TB;
Notas del editor
It is transmitted from person to person via droplet nuclei containing the organism and is spread mainly by coughing
occurs most commonly in children but is being seen with increasing frequency in adults
at level of basal trunk using mediastinal window set ting
obtained shows enlarged right hilar and subcarinal lymph nodes (arrows), central necrotic low attenuation, and peripheral rim enhancement
Most commonly the right paratracheal and hilar lymph nodes are involved
Tb bacilli are inhaled into the lung
more ventilated areas of the lung—typically in the middle to lower regions(subpleural sites)
suggestive of the disease, especially in adults.
When there is a combination of a parenchymal granuloma and an involved hilar lymph node on the same side, the two together are called a “Ghon Complex”
Several other, small calcified granulomas are seen in the right mid-lung field
, related to parenchymal granulomatous inflammation
setting shows airspace consolidation in right middle lobe. Note enlarged right hilar and subcarinal lymph nodes (arrows). Hilar node has necrotic low attenuation.
In this particular situation, the determination of pleural fluid adenosine deaminase
(ADA) level
Radiographic manifestations of post-primary tuberculosis overlap with those of primary disease, there are several distinguishing features:
Cavitation is an important characteristic of post-primary tuberculosis. In tuberculosis, cavities occur as the result of an area of caseous necrosis communicating with an airway and usually contain the highest concentration of mycobacteria of any tuberculous lesion
HRCT CENTRILOBULAR NODULES containing several thick walled cavities in both upper lobes. Note branching nodular and linear opacities (tree-in-bud signs)
Because miliary nodules result from hematogenous dissemination, more are present in the lower lung zones, due to greater blood flow to the bases compared with the
apices of the lungs.
conditions that are associated with defects in cell-mediated immunity, such as HIV infection; malnutrition; drug and alcohol abuse; malignancy; end-stage renal disease;
diabetes mellitus; and corticosteroid or other immunosuppressive therapy [
High-resolution CT image. Note subpleural and subfissural nodules (arrows).
Diffuse or localized groundglass opacity is sometimes seen, which may herald acute respiratory distress syndrome
pulmonary nodule in the left middle zone.
B) CECT of the chest shows eccentric cavitation of the nodule. CT-guided aspiration revealed
caseous material positive for Mycobacterium tuberculosis
Here we have a patient with atelectasis of the right upper lobe as a result of TB.
Notice the deviation of the trachea.
Frontal radiograph shows a mass of soft-tissue
opacity with an air-crescent sign
Thickening of the walls of a tuberculous cavity or of
the adjacent pleura is reported to be an early radiographic
sign.
Contrast-enhanced CT scan shows a low-attenuation
soft-tissue mass (M) within the cavity, along with the air-crescent sign
Bronchiectasis located in
the apical and posterior segments of the upper
lobe is highly suggestive of a tuberculous origin
Commonly it occurs by destruction and fibrosis of the lung parenchyma with secondary bronchial dilatation (traction bronchiectasis)
shows an example of a tuberculous empyema that developed when a cavitary tuberculous
pneumonia ruptured into the pleural space, creating a bronchopleural fistula.
Frontal chest radiograph shows consolidation with a cavity in the right upper lobe (arrow). There are patchy and nodular areas of increased opacity in the left middle
lung zone (arrowheads). (b) Frontal radiograph obtained 2 months after a shows multiple air-fluid levels in the right hemithorax (arrowheads).
CECT image shows ostium of the
enlarged right bronchial artery
CT scan obtained 15 mm inferior to A shows contrast-enhancing round vascular structure (arrow) in consolidative lesion
weakening of the arterial wall occurs as granulation tissue replaces both the adventitia and the media. The granulation tissue in the vessel wall is then gradually replaced by fibrin, resulting in thinning of the arterial wall, pseudoaneurysm formation, and subsequent rupture
CECT of
patients with postprimary pleural effusion shows smooth
thickening of visceral and parietal pleura giving splitpleura
sign
Contrast-enhanced CT scan shows narrowing
of the left main bronchus (arrow) without significant wall thickening, enhancement, or calcification
Contrast-enhanced
CT scan shows a lobulated mass with eccentric calcifications (white arrows) in the right upper lobe. There is pleural
(arrowheads) and extrapleural (black arrows) fat thickening adjacent to the mass which is suggestive of chronicity
Broncholithiasis in a 58-year-old man who presented with a cough. Contrast-enhanced CT scan shows a broncholith (arrowhead) within the lateral
segmental bronchus of the right middle lobe. There is distal obstructive atelectasis and calcified lymph nodes (arrows) adjacent to the bronchi. A right pleural effusion
is noted.
Chest radiograph depicting curvilinear pericardial calcification over left heart border
Frontal chest radiograph shows consolidation with a cavity in the right upper lobe (arrow). There are patchy and nodular areas of increased opacity in the left middle
lung zone (arrowheads). (b) Frontal radiograph obtained 2 months after a shows multiple air-fluid levels in the right hemithorax (arrowheads).