The Radiology of Tuberculosis

Ronald J. Karpick, M.D.

Fairfax County Health Department

9/15/09

New England TB Intensive

Fairfax County, VA

Population 10.5 Million

400 square miles

The Nations Capitol is 9.6 miles from my office

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

Lead Shield X-ray tubeFilm

Posterior-Anterior (PA) Chest X-ray

Grant’s Atlas of Anatomy 11th Ed

F.J. Netter, Respiratory System, Ciba

Collection, 1980

F.J. Netter, Respiratory System, Ciba Collection, 1980

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 Hypersensitivity and Cell Mediated Immunity within 8 weeks

Ghon

focus

a calcified

granuloma

Ghon focus and enlarged

ipsilateral LN=Ranke

Complex/Ghon Complex

Primary TB

FJC 2.1

FJC 2.9a

PRIMARY TB

MEDIASTINAL AND HILAR LN

Right Hilar

LN

Subcarinal

LN

CAT Scan w Contrast

L

post

PET Scan

Positive

Emission

Tomography

Radiolabeled

Glucose

FJC 2.11PRIMARY TB, LN & INFILTRATE

FJC 2.4

PRIMARY TB

CONSOLIDATED RIGHT UPPER

LOBE, NO AIR BRONCHOGRAMS

FJC 2.12

PRIMARY TB-PLEURAL EFFUSION

Pleural Effusion pushing mediastinum to the left

Primary Tuberculosis

in adolescents and

young adults

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 primary infection if it occurs within a year of the initial 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

FJC 2.13a

POST PRIMARY or REACTIVATION

TUBERCULOSIS

FJC 2.16

REACTIVATION TB WITH RUL CAVITY

AND BRONCHIAL SPREAD TO THE

LEFT LUNG

Tree-in-Bud

appearance

Tree-in-bud appearance of TB

in a High Resolution CAT

scan

Respiratory

bronchiole

Alveolar duct

Eisenhuber, Radiology 2002;222:771-72

Tree-in-Bud

Dense calcification

in Right Upper

Lobe

Post Primary Tuberculosis

Reactivation TB

Miliary Tuberculosis

Miliary Tuberculosis

CAT Scan

Millet seeds

CENTRAL NERVOUS SYSTEM

Infiltrating process

MRI

Infiltrating process with pressure

compressing the brain

edema

Tuberculosis

mass

CAT Scan

Tuberculomas in the Brain

MRI

TB Meningitis on cortex and Sylvian

fissure, MRI with contrast

R

Skeletonal TB

Anterior

Collapsed

Vertebrae

Spinal Cord

MRI

Abscess

TB Osteomyelitis (Pott’s Disease)

CAT scan with contrast

Moore &

Rafii,Radiol.Cl.

N.A 2001;39(2):

336

TB of the

head of

the Femur

TB of the

Head and

Neck of

the

Femur

Tuberculosis Arthritis of

the knee

Moore &

Rafii,Radiol.Cl

.N.A

2001;39(2):

336

TB of the

Elbow

Gastrointestinal TB

Mixed

ulcero-

hypertro-

phic

M. Tb of the colon

12-7-07

CAT Scan with contrast

HIV +, liver and SpleenTW

CAT scan with Contrast

Peripheral Lymph Node

Tuberculosis

3-27-09

Lymph

Node

Genital-Urinary TB

Renal TB

TW

IVP

Pericardial TB

Water Bottle Heart

CAT Scan

Today’s Objectives

• Learned how Radiation is produced and how much an individual receives during a CXR

• 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 in other organ systems

References

• Radiographic Manifestations of Tuberculosis, 2nd

Ed., Daley et al., 2006, Francis J. Curry National Tuberculosis Center

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

• Tuberculosis from Head to Toe, Harisinghani et al., 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/

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

Questions ???