1 PULMONARY TUBERCULOSIS - RADIOLOGICAL IMAGES - Dr. Miron RamonaConf Dr Antigona Trofor
2 TUBERCULOSIS RADIOLOGY Pulmonary tuberculosis, especially postprimary disease, nearly always causes abnormalities on chest radiographs.Typically, the disease is parenchymal without nodal enlargement, and it manifests as cavitary lesions.Upper-lobe involvement with cavitation and the absence of lymphadenopathy are helpful in distinguishing postprimary TB from primary TB.In addition to the usually involved pulmonary segments—namely, the apical or posterior segments of the upper lobe or the superior segment of a lower lobe—anterior or basal segments may be involved in as many as 75% of cases.
3 PRIMARY TUBERCULOSIS RADIOLOGY Radiographic screening for active TB in high-risk populations may demonstrate findings consistent with prior and/or current infection.A Ghon focus refers to the initial site of parenchymal involvement at the time of first infection;A Ranke complex is the combination of a Ghon focus and enlarged or calcified lymph nodes;Lymphadenopathy is the radiologic hallmark of primary TBSimon focus are apical nodules that are often calcified and result from hematogenous seeding at the time of initial infection
6 Complexul primar Ranke: GOHN focus (alveolitis)=basal subpleural nodular opacities (most often on right), flou contourLymphangitis: radiological expression, in some case appear fibrosis; fine linear opacities that connect the Gohn focus with hilumHomolateral adenopathy: hilary, interbronchial or paratracheal rounded shape, massive polyciclic aspect,321
7 Complex formsExcavation of caseous alveolitis focus– primary cavern (cavity) transparent thin wall or anfractuous circumscribed, usually localized on the basal or middle lung fields, is accompanied by hilary adenopathy.Voluminous adenophaties: cause ventilation modifications by extrabronchial compression, obstructive emphysema or systematized atelectasis
8 Vouluminous right hilar adenopathy Segmental atelectasis in upper right lobe
9 Complicated forms Large cavitary tuberculosis with forms: Pneumonia: triangular opacity- Can do to excavationIs accompanied by adenopathyPneumonie TB lob superior drept
10 Associated adenopathies! Bronchopneumonia:Macronodulare alveolar opacities, various sizes, unequal distribution, with a tendency to confluenceAssociated adenopathies!Right paratracheal adenopathyMiliary nodules
12 Miliary tuberculosis Complication of Primary TB Radiological: miliary opacities with diameter < 3 mm, equal in size, homogeneous distribution
13 Secondary tuberculosis Occurs due to reactivation of primary tuberculosisReactivation of fibrotic lesions from apical territoryReinfection by exogenous contaminationCan occur after primary infection,Radiology- polymorphic semiology!Alveolar opacities systematized/nonsystematized;Nodular images, cavitary lesions, fibrous lesions, associated lesionsThe affected territories predilection: dorsal and apical segments of upper lobes and apical segments of lower lobes!
22 TB PLEURAL EFFUSIONIn a patient with pleural exudate, TB is the first etiology to be taken into consideration!
23 Radiological aspect of cavities(caverns) depends on the stage in which there are: Cavity grade 1Cavity grade 2Cavity grade 3Cavity grade 1:Lucency (darkened area) within the lung parenchyma, with or without irregular margins
24 CAVITY GRADE 2 :wall has its own thin, elastic, net contour Cavern with net wall localized RUL subclavicular
25 Cavity grade 2Between cavern and hilum- drainage bronchia
39 ” Complications of cavitary TB – bronchogenic dissemination Micronodular opacities, diffuse shape, vaguely defined, tendency to confluence to delimit small areas excavated
40 Complications of cavitary TB – bronchogenic dissemination Bronchogenic dissemination from RUL to LIL (disemination type “Cardis”)
41 Complications of cavitary TB – bronchogenic dissemination Hiperlucency excluding left lung, with attraction of trachea to the left, ascension compensatory of the diaphragm, hyperinflation of contralateral lung, right lung shows extensive infiltrative lesions and a cavity to the apexImages - multi-drug resistance TB
42 Miliary TB - miliary nodules distributed homogenous in both lung fields
43 POSTUBERCULOSIS FIBROSIS Retraction of LUL with fibrous lesions extended to right lungBasal left pachipleuritis
44 FIBROTHORAX -The final process of sclerosis that interested entirely the lung Sclerosis of right lungRetraction of left hemithoraxNodular lesions of left lung
45 5. TuberculomaRadiological: round, oval, encapsulated opacity, homogeneous or heterogeneous structure, net shape, can be solitary or multiple lesionsSeriate radiographs show stability in time!