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Health Dictionary

Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Multi-drug-resistant tuberculosis CT

Introduction

Overview

Overview

The majority of patients with pulmonary tuberculosis will have abnormal findings in a chest CT, which include micronodules, interlobular septal thickening, cavitation and consolidation. CT scan is more sensitive than an X-ray to detect lymphadenopathies.

Computed Tomography

Computed Tomography

Pulmonary Tuberculosis

  • Chest CT abnormalities are seen in the majority of patients with active pulmonary tuberculosis.
  • CT findings include:[1]
  • Micronodules
  • Most commonly located in the subpleural region and peribronchovascular interstitium.
  • CT scan allows an early and accurate detection of micronodules.
  • Interlobular septal thickening
  • Cavitation is the most important finding in secondary tuberculosis
  • Appears as a lesion with thick walls and irregular margins.
  • It may be observed in almost 50% of patients.
  • It is most commonly seen in the upper lung.
  • Cavities in the lower lung can be found in diabetes and HIV infection.[2][3]
  • Although it is rare, cavities may be superinfected and an air-fluid level is seen inside the cavity.
  • After the active infection is treated, small cavities with thin walls may remain as a residual finding.
  • Homogeneous and dense consolidation
  • CT is more sensitive to detect hiliar lymphadenpathy.
  • The “tree-in-bud” sign is a CT finding that may be seen in pulmonary tuberculosis and it is caused by mucus or pus impaction into the small airways that accentuates the branching course of peripheral airways.[4]
Pulmonary Tuberculosis
Image courtesy of Dr Natalie Yang, Radiopedia. (original file here) Creative Commons BY-SA-NC
Pulmonary Tuberculosis
Image courtesy of Dr Natalie Yang, Radiopedia. (original file here) Creative Commons BY-SA-NC
Chest CT showing a tuberculous cavity in the left lung.
Image courtesy of Wikimedia Commons.

Extrapulmonary Tuberculosis

Cardiac Tuberculosis

  • Pericardial thickening may be seen in a CT, specially if it is more than 3 mm.[5]
  • Lymph node enlargment is also a common CT finding in cardiac tuberculosis.[5]
  • Pericardial effusion is seen in less than 20% of patients.[5]

Miliary Tuberculosis

CT findings include multiple pulmonary nodules with a diameter of 1-2mm, distributed in a random pattern, pleural effusion may also be present.

Miliary Tuberculosis
Image courtesy of Dr Frank Gaillard, Radiopedia. (original file here) Creative Commons BY-SA-NC
Miliary Tuberculosis
Image courtesy of Dr Frank Gaillard, Radiopedia. (original file here) Creative Commons BY-SA-NC

Tuberculous Meningitis

  • Head CT findings in tuberculous meningitis include meningeal enhancement consistent with meningeal inflammation and choroidal calcifications.[6]
  • Areas of infarction and hemorrhage may also be seen in cases of miliar tuberculosis.
  • Patients with late complications may show hydrocephalus.
Image courtesy of Wikimedia Commons.

Abdominal Tuberculosis

  • CT findings in a pancreatic and spleen infection with tuberculosis may mimic a pancreatic cancer.[7]
  • Shown below there is CT scan of the pancreas demonstrating a mass in the pancreatic tail and metastasizes in the spleen.
Image courtesy of Wikimedia Commons.
Image courtesy of Wikimedia Commons.
References

References

  1. ↑ Jeong Min Ko, Hyun Jin Park & Chi Hong Kim (2014). “Pulmonary Changes of Pleural Tuberculosis: Up-to-Date CT Imaging”. Chest. doi:10.1378/chest.14-0196. PMID 25086249. Unknown parameter |month= ignored (help)
  2. ↑ Patel, AnandK; Rami, KiranC; Ghanchi, FerozD (2011). “Radiological presentation of patients of pulmonary tuberculosis with diabetes mellitus”. Lung India. 28 (1): 70. doi:10.4103/0970-2113.76308. ISSN 0970-2113.
  3. ↑ Padyana, Mahesha; Bhat, RaghavendraV; Dinesha, M; Nawaz, Alam (2012). “HIV-Tuberculosis: A Study of Chest X-Ray Patterns in Relation to CD4 Count”. North American Journal of Medical Sciences. 4 (5): 221. doi:10.4103/1947-2714.95904. ISSN 1947-2714.
  4. ↑ Eisenhuber, Edith (2002). “The Tree-in-Bud Sign1”. Radiology. 222 (3): 771–772. doi:10.1148/radiol.2223991980. ISSN 0033-8419.
  5. ↑ 5.0 5.1 5.2 Burrill, Joshua; Williams, Christopher J.; Bain, Gillian; Conder, Gabriel; Hine, Andrew L.; Misra, Rakesh R. (2007). “Tuberculosis: A Radiologic Review1”. RadioGraphics. 27 (5): 1255–1273. doi:10.1148/rg.275065176. ISSN 0271-5333.
  6. ↑ Komolafe, Morenikeji A; Sunmonu, Taofiki A; Esan, Olufunmi A (2008). “Tuberculous meningitis presenting with unusual clinical features in Nigerians: Two case reports”. Cases Journal. 1 (1): 180. doi:10.1186/1757-1626-1-180. ISSN 1757-1626.
  7. ↑ Rong, YF; Lou, WH; Jin, DY (2008). “Pancreatic tuberculosis with splenic tuberculosis mimicking advanced pancreatic cancer with splenic metastasizes: a case report”. Cases Journal. 1 (1): 84. doi:10.1186/1757-1626-1-84. ISSN 1757-1626.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]