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The Radiology of Tuberculosis

Ronald J. Karpick, M.D.

Fairfax County Health Department9/15/09

 New England TB Intensive

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Fairfax County, VA

Population 10.5 Million

400 square miles

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The Nations Capitol is 9.6 miles from my office

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Today’s Objectives

• Learn how Radiation is produced and how

much an individual receives during a CXR 

• Learn the major landmarks of the CXR 

• Learn to distinguish Primary and Post

 primary Pulmonary TB on the CXR 

• Review the appearance of TB infection in

other organ systems

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Lead Shield X-ray tubeFilm

Posterior-Anterior (PA) Chest X-ray

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Grant’s Atlas of Anatomy 11th Ed

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F.J. Netter, Respiratory System, CibaCollection, 1980

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Primary Tuberculosis

• First infection with M. tuberculosis

• Most commonly by way of inhaled air 

• Primary or Ghon focus• Lymphatic spread

• Hematogenous spread

• Development of Delayed Hypersensitivityand Cell Mediated Immunity within 8weeks

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Ghonfocus

a calcified

granuloma

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Ghon focus and enlarged

ipsilateral LN=Ranke

Complex/Ghon Complex

Primary TB

FJC 2.1

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FJC 2.9a

PRIMARY TB

MEDIASTINAL AND HILAR LN

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Right Hilar LN

Subcarinal

LN

CAT Scan w Contrast

L

 post

PET S

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PET Scan

Positive

Emission

Tomography

Radiolabeled

Glucose

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FJC 2.11PRIMARY TB, LN & INFILTRATE

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FJC 2.4

PRIMARY TB

CONSOLIDATED RIGHT UPPER 

LOBE, NO AIR BRONCHOGRAMS

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FJC 2.12

PRIMARY TB-PLEURAL EFFUSION

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Pleural Effusion pushing mediastinum to the left

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Primary Tuberculosis

in adolescents and

young adults

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Post-Primary or Reactivation TB

• Reactivation of a previously dormant

 primary infection, though in a small number of cases, it is the extension of the primaryinfection if it occurs within a year of theinitial infection.

• It is a disease of adolescents and adults

• It affects primarily the upper lobes with a propensity to cavitate,

• Extra pulmonary sites include the LN,Pleura, bone, CNS, GU, Peritoneum

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FJC 2.13a

POST PRIMARY or REACTIVATION

TUBERCULOSIS

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FJC 2.16

REACTIVATION TB WITH RUL CAVITY

AND BRONCHIAL SPREAD TO THE

LEFT LUNG

Tree in Bud

Tree in bud appearance of TB

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Tree-in-Bud

appearance

Tree-in-bud appearance of TB

in a High Resolution CAT

scan

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Respiratory

 bronchiole

Alveolar duct

Eisenhuber, Radiology 2002;222:771-72

Tree-in-Bud

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Dense calcification

in Right Upper 

Lobe

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Post Primary Tuberculosis

Reactivation TB

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Miliary Tuberculosis

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Miliary Tuberculosis

CAT Scan

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Millet seeds

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CENTRAL NERVOUS SYSTEM

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Infiltrating process

MRI

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Infiltrating process with pressure

compressing the brain

edema

Tuberculosismass

CAT Scan

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Tuberculomas in the Brain

MRI

TB Meningitis on cortex and Sylvian

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TB Meningitis on cortex and Sylvian

fissure, MRI with contrast

R 

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Skeletonal TB

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Anterior 

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CollapsedVertebrae

Spinal Cord

MRI

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 Abscess

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TB Osteomyelitis (Pott’s Disease)

CAT scan with contrast

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Moore &

Rafii,Radiol.Cl.

 N.A 2001;39(2):

336

TB of the

head of the Femur 

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TB of the

Head and

 Neck of 

the

Femur 

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Tuberculosis Arthritis of 

the knee

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Moore &Rafii,Radiol.Cl

.N.A

2001;39(2):

336

TB of theElbow

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Gastrointestinal TB

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Mixed

ulcero-

hypertro-

 phic

M. Tb of the colon

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CAT S ith t t

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12-7-07

CAT Scan with contrast

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CAT scan with Contrast

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HIV +, liver and SpleenTW

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Peripheral Lymph Node

Tuberculosis

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3-27-09

Lymph

 Node

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Genital-Urinary TB

Renal TB IVP

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Renal TB

TW

IVP

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Pericardial TB

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Water Bottle Heart

CAT Scan

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CAT Scan

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Today’s Objectives

• Learned how Radiation is produced andhow much an individual receives during aCXR 

• Learned the major landmarks of the CXR 

• Learned to distinguish Primary and Post primary Pulmonary TB on the CXR 

• Reviewed the appearance of TB infection inother organ systems

References

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References

• Radiographic Manifestations of Tuberculosis, 2nd

Ed., Daley et al., 2006, Francis J. Curry NationalTuberculosis Center 

• Diagnosis of Diseases of the Chest, Fraser & Pare’WB Saunders, 1970

• Tuberculosis from Head to Toe, Harisinghani etal., RadioGraphics 2000; 20: 449-470

• Introduction to Chest Radiology; SB Gay et al.,UVA Health Science Center, Department of Radiology, 2003

www.med-ed.virginia.edu/courses/rad/

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References

• Atlas Radiologic Anatomy; L.Wicke, 7th English

Edition, Icon Learning Systems, 2004

• Blueprints Radiology; A. Uzelac and RW Davis,Lippincott Williams & Wilkins, 2006

• Introduction to Diagnostic Imaging; G. Stimac,

WB Saunders 1992

• Getting Started in Clinical Radiology; G. Eastman,Wald and Crossin, Thieme, 2006

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Questions ???