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Joseph Junewick, MD FACR
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Pulmonary TB

Case Detail

Anatomy: Chest
Borders
Heather Borders, MD
Diagnostic Category: Infectious-Inflammatory
Created: over 7 years ago
Updated: over 7 years ago
Tags: PEDS
Modality/Study Types: CT
Activities:
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History

6 month old adopted from Africa with respiratory symptoms. Reportedly, the patients mother had passed away from TB.


Case Images


Diagnosis

Primary pulmonary TB

Findings

Calcified hilar and mediastinal lymph nodes and partially calcified dense right upper lobe infiltrate with indistinct margins and mild surrounding nodularity.

Discussion

Pulmonary tuberculosis is classically divided into primary and postprimary (reactivation) tuberculosis. There is considerable overlap in the radiologic manifestations of these two entities.

Although primary tuberculosis is the most common form of pulmonary tuberculosis in infants and children, it has been increasingly encountered in adult patients. Primary tuberculosis typically manifests radiologically as parenchymal disease, lymphadenopathy, pleural effusion, miliary disease, or atelectasis, which may be either lobar or segmental. However, results of chest radiography may be normal in 15% of cases.

Parenchymal disease in primary tuberculosis affects the areas of greatest ventilation; the most common sites are the middle lobe, the lower lobes, and the anterior segment of the upper lobes.

The radiologic differential diagnosis for tuberculous lymphadenopathy includes metastases and histoplasmosis in endemic areas.

At CT, primary tuberculosis typically manifests as air-space consolidation that is dense, homogeneous, and well defined.

Postprimary disease results from reactivation of a previously dormant primary infection in 90% of cases; in a minority of cases, it represents continuation of the primary disease. The radiologic features of postprimary tuberculosis can be broadly classified as parenchymal disease with cavitation, airway involvement, pleural extension, and other complications.

Reference

March 2000 RadioGraphics, 20, 449-470. Tuberculosis from head to toe.



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