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Chest radiographs and TB Graham Bothamley Jean-Paul Zellweger.

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Presentation on theme: "Chest radiographs and TB Graham Bothamley Jean-Paul Zellweger."— Presentation transcript:

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2 Chest radiographs and TB Graham Bothamley Jean-Paul Zellweger

3 Plan of session 1.The typical chest x-ray of TB 2.Atypical chest x-rays 3.Extrapulmonary TB on the chest x-ray 4.Inactive tuberculosis 5.The normal chest x-ray with C+PTB 6.Differential diagnoses

4 What are the typical features of tuberculosis on a chest x-ray?

5 Chest x-rays StudyUnder-reading % of positives Over-reading % of negatives 5 experts25- General271.7 Mass radiography321.7 Danish mass radiography321.6 Reader panel (15,000) best radiologists best physicians260.3 Average322 Improvement only if >20,000 films read annually. Nakamura et al. Kekkaku 1970; 45:121

6 Conclusions from mass x-ray surveys Sudden, symptomatic onset as common as insidious onset Disease extent unrelated to duration (extensive S+PTB within first 3-6 m) Cavitation is not a late occurrence – its frequency is nearly the same at all temporal stages of the disease Toman. Case finding and chemotherapy. WHO, Geneva, 1979

7 Atypical TB Lower zone No cavitation (miliary)

8 Atypical TB Female Diabetes HIV Elderly

9 Extrapulmonary TB Mediastinal lymph nodes Pleural effusions Paraspinal abscess Spinal disease

10 Pleural effusion

11 Pericardial TB

12 TB of the spine

13 Inactive or self-healed tuberculosis Primary focus/calcified granuloma Coin lesion Fibrosis

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15 The normal chest radiograph with a positive M.tb culture Single isolate or repeated? Lab contamination – strain typing CT scan Treat?

16 Differential diagnosis Non-tuberculous mycobacterial disease Sarcoidosis Fungal disease

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18 M. xenopi

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20 NTMD Background of COPD Thicker pleural reaction

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22 M. fortuitum

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26 Bronchiectasis Tree in bud Nodules

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28 Mycobacterium spp. Runyon group III

29 The Quiz Estimate the probability of the diagnosis of tuberculosis and indicate whether you think the person will be sputum smear-positive Read the histories and estimate a prior probability of TB Look at the CXRs again – in a different order this time and again estimate the probability of TB and whether the sputum smear will be positive

30 Exercise: 20 CXRs Estimate the probability of TB

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