2 Pulmonary TB, main radiological aspects and differential diagnoses Common TB in adultsMiliarySerous membrane TBNode TBPleural TBSequelaTuberculosis and AIDS: AIDS modifies the clinical and radiological course of TB. Differential diagnoses are many. It is important to know them, in order to chose the adapted treatment
3 Common adult TB Basic radiological images: NoduleInfiltrateCavityTuberculous pneumonia
4 These elements are very often associated in the same patient - These images can follow in time :nodule macronodule excavated nodule cavernaThese elements are very often associated in the same patientThe association of several images of different ages and different aspects is very indicative for TBRound picture with a diameter > 3 cm, non- excavated, is very rarely TB
5 Nodule: isolated or grouped in the superior lobes or in the apical segment of the inferior lobes. Infiltrate: group of various-sized nodules with unequal dimensions. The excavation is not always visible on the chest x-ray. If the excavation exists, the bacterial analysis of the sputum is generally positive: TPM+. (The TDM could show the excavation even if it is not visible on the chest x-ray)
6 .For the supra clavicles area analysis, the chest x-ray with antero posterior incidence is usefull.
22 nodule macronodule cavited nodule cavity In this case, association of an infiltrate in the right superior lobe and cavity in the left inferior lobe is highly indicative of TB
23 TB nodules and infiltrates are most often isolated or grouped in the superior lobes or in the apical segment of the inferior lobes.- They are difficult to see in the retro-clavicle area- These lesions are often AFB- because non-excavated, no communication with bronchi and pauci-bacillar- The association of lesions with different seniority (nodules, cavity, sequelas) or with extra pulmonary localisations is very indicative of TB.
24 Nodules and infiltrates are often AFB- in sputum Nodules and infiltrates are often AFB- in sputum. So the risk of contamination is low (but not zero).AFB is negative in sputum, but sometimes cultures are positive.Even if the risk of contamination is low, it is important to detect these patients and treat them because these patients can develop severe and contaminent TB
25 Cough, fever, weight loss, asthenia Male, 30 years oldCough, fever, weight loss, astheniaT left upper lobe infiltrate not noticedby the physician (not good qualityof CXR)Amoxicillin treatment…
26 4 months later: left superior excavation with important infiltrate, AFB +++
27 Nodules and Infiltrate -Summary Sometimes difficult to see (small, retroclavicular areas)Sometimes AFB+ if cavity (not always visible on CXR)Most often no cavitation and AFB-They are true TB on the beginning and must be treated by anti TBThey are true TPM -Physicians of national TB program hesitate to treat these patients but they treat a lot of “TPM – who are not real TB (bronchial cancer, inactive sequella bronchectasis, aspergilloma…)It is absolutely necessary to improve quality of CXR interpretationEspecially for physicians in charge of TB program.