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This document provides information on imaging modalities used to diagnose pulmonary tuberculosis. It discusses the advantages and disadvantages of chest x-ray, ultrasound, CT, MRI, and nuclear imaging. Key findings on imaging for primary TB include lymphadenopathy, parenchymal lesions, and pleural effusions. Complications include cavitations, bronchiectasis, and airway stenosis. Atypical presentations can include normal chest x-rays or lower lobe infiltrates in late stage disease. PET scans provide high sensitivity but low specificity in TB diagnosis.

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Dr Hasna E JR 3 Pulmonary medicine
Dr. B. Vidyasagar , Professor & Head of Department Dr. Rajesh B.P. , Associate Professor Dr. Akshay M.Hiremath , Associate Professor Dr. Arjun H. , Associate Professor Dr. Santhosh V.G. , Associate Professor Dr. Nandish C. , Associate Professor Dr. Adheep B.Amberker , Assistant Professor
Disease caused by M TB in person with no previous exposure
CHEST XRAY ULTRASOUND CT SCAN MRI NUCLEAR IMAGING
MODALITY ADVANTAGES DISADVANTAGES Radiography Inexpensive, easily available Radiation exposure Low sensitivity and specificity Ultrasonography Radiation free,portable,guide pleural sampling Limited field of view Computed tomography Excellent resolution, high sensitivity, guide sampling Radiation,iodinated,relatively expensive Magnetic resonance imaging Radiation free,Accurate for lymphadenitis and associated spinal disease Expensive,CI,less accurate for parenchymal lesions PET CT/PET High sensitivity Low specificity,radiation exposure
TYPICAL RADIOLOGRAPHIC PATTERN OF PRIMARY TUBERCULOSIS POST PRIMARY TUBERCULOSIS COMPLICATION OR SEQUEALE OF TB ATYPICAL PATTERNS
Radiological Features of primary TB Lymphadenopathy Parenchymal consolidation Tuberculoma Miliary Tb Pleural Effusion Airway involvement Commonly in children Structure involved Lymphnode ,Pulmonary parenchyma ,pleura, Tracheobronchial tree
83-96% pediatric cases. 10-43% adults. m/c site Right paratracheal and Hilar region. WHY RIGHT SIDED? In a study -Subcarinal>hilar>anterior mediatinum> precarinal>Right paratracheal. B/L lymphadenopathy 31%cases CT higher sensitivity >CXR Lymphnode >1cm in SAD considered enlarged. LYMPHADENOPATHY
Stage Of Lymphoid Hyperplasia Homogeneous Enhancement Stage Of Caseous Necrosis Heterogeneous Enhancement With Small Necrotic Area In Early stage Peripheral Thin Rim Enhancement With No Central Enhancement Stage Of Periadenitis Peripheral Irregular Enhancement With Central Non Enhancement with clear surrounding fat plane Stage Of Liquefaction Peripheral Rim Enhancement With Central Enhancement and obliterated surrounding fat plane pretracheal Hilar and subcarinal
1 Homogeneous Enhancement 2 Inhomogeneous with strong peripheral enhancement 3 No contrast enhancement Mediastinal and hilar lympahdenopathy Hilar and subcarinal
Lymphnode +Draining lymphatics called Primary complex. Subpleural lesion-middle portion of lung Upper region of lower lobe, lower portion of middle lobe(Right side) PARENCHYMAL LESION
GHONS focus +enlarged or calcified lymphnode.
Small round/oval opacity in primary and postprimary tb Seen in 7-9% patients 0.5 to 4cm diametre seen commonly -Upperlobe right side Satellite lesion in 80 %cases
Primarily seen in primary tb,although may be seen in post primary Innumerable 2mm or less non calcified nodules scatttered throughout lung Mild basilar preponderance. Coalesce -Snowstorm apparence(3-5mm) HRCT more sensitive .
PLEURAL INVOLVEMENT IN TB PLEURAL EFFUSION Uncommon in primary TB Develops same side of initial TB Bilateral effusion 12% cases USG Pleural effusion can be quantified,evaluation of septations,sampling 10 ml
Unilateral >90% cases Smallto moderate in size 10% case Large effusion CT more sensitive Pleural based nodules identified-Pseudotumour
Enhancement of thickened inner visceral and outer parietal pleura with separation by pleural fluid SPLIT PLEURA SIGN TB EFFUSION fail to resolve Chronic suppurative form Fibrous scar tissue
Occur in chronic cases Usually occur as result of fibrin deposition causing thickening ,adhesion and calcification.
Can be extrinsic due to compression by enlarged lymphnode Lymphnode compression leads to atlectasis or hyperinflation. Occurs level of lobar bronchus or bronchus intermedius Anterior segment of UPPER LOBE OR MEDIAL SEGMENT OF MIDDLE LOBE Intrinsic by endobronchial spread
FEATURES OF ACTIVE TB ON CT Centrilobular nodules Lobular consolidations Cavitations Bronchial wall thickening Necrotic mediastinal and hilar lympahdenopathy Pleural Effusion
Predilection of apical and posterior segment of upper lobe superior segment of lower lobes Rarity of lymphadenopathy. Propensivity for calcification.
Cavitation Local exudative lesion Local fibroproductive lesion Tuberculoma Bronchogenic spread Miliary tb Bronchostenosis Pleural disease
m/c lesion focal or patchy heterogenous consolidation involving apical or posterior segment of UL or superior segment of LL Poorly defined Nodules Cavitation 45% cases Lobar or total lung consolidation.
Healing replacement of TB granulation tissue by fibrous tissue Fluffy opacity well defined reticular and nodular opacity
Occurs when area of caseation necrosis liquefies. Cavity in 40-45 % patients. Wall of cavity ----thin and smooth ----Nodular Air fluid level are uncommon in TB MYCETOMA intracavitary fungal ball
occurs in 95% cases due to communication to tb cavity or intrabronchial rupture. TREE IN BUD appearance Acinar nodule-5mm
Direct extension from adjacent parenchyma. Occurs due to cavitation,lymphnode erosion,hematogenous spread, extension due to the peribronchialregion. Sub mucosal site of infection Ulcerations Heals by fibrosis with circumferential stenosis
Parenchymal Complication Airway Complication Pleural Complications Vascular Complications Mediastinal Complications Chest Wall Complications
Can occur consequence of cicatrization of Previous active tb cavity after therapy sequeale of ARDS
Ectatic bronchus or residual tb cavity colonised by Aspergillus species. CT-Mobile intracavitary nodule or mass surrounded By air
Characterised by artitectural distortion,calcification Retraction of adjacent parenchyma
Occur in severe TB MILIARY TB OR TB BRONCHOPNEUMONIA Predisposing factors-Malnutrition,Alcoholism,diabetes mellitus,Immunosuppressive therapy,HIV infection, Pregnancy
BRONCHIECTASIS Due to destruction and fibrosis of lung parenchyma result in retraction and irreversible bronchial dilatation
BRONCHOLITH BRONCHOSTENOSIS Endogenous Calcified material Chronic narrowing of bronchus
Hasna ppt.pptx
Empyema communicate with bronchial tree by bpf and shows air fluid level
Hasna ppt.pptx
Pseudoaneurysm Weakening of pulmonary artery wall by adjacent Cavitary TB AIR CRESCENT on cxr CTPA confirm diagnosis
Soft tissue encasing major vessels and airway
Pleural collection track exteriorly through chest wall
Atypical findings Early stage-Typical post primary TB with upper lobe infiltrates Late stage-Noncavitatory,lower lobs infiltrates,Hilar adenopathy,pleural effusion
Coexist with extensive pulmonary parenchymal or intrathoracic lymphnode infection. 10-20% have Normal Chest Xray
Refers to imaginary horizontal line traced across hilum includes parahilar region. Includes middle lobe and lingula with lower lobes. Large cavities 3-4 cm. Pt receiving corticosteroids Hepatic /Renal disease DM Pregnancy HIV
Silicosis-Pneumoconiosis caused by inhalation of silica Coexistance of TB AND SILICOSIS called silicotuberculosis 3-7% increased incidence of TB in person with silicosis.
FIBROTIC MASS
Primary TB M/C form in children Lymphadenopathy mayb only feature in primary TB Cavity less common in children
Hasna ppt.pptx
Newer imaging modality Quantifiable-Amount of radiation depends on rate of metabolic activity Non invasive Appear as focal increase in FDG uptake Can detect early response of treatment by quantitative reduction in FDG uptake.
Hasna ppt.pptx

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Hasna ppt.pptx

  • 1. Dr Hasna E JR 3 Pulmonary medicine
  • 2. Dr. B. Vidyasagar , Professor & Head of Department Dr. Rajesh B.P. , Associate Professor Dr. Akshay M.Hiremath , Associate Professor Dr. Arjun H. , Associate Professor Dr. Santhosh V.G. , Associate Professor Dr. Nandish C. , Associate Professor Dr. Adheep B.Amberker , Assistant Professor
  • 3. Disease caused by M TB in person with no previous exposure
  • 4. CHEST XRAY ULTRASOUND CT SCAN MRI NUCLEAR IMAGING
  • 5. MODALITY ADVANTAGES DISADVANTAGES Radiography Inexpensive, easily available Radiation exposure Low sensitivity and specificity Ultrasonography Radiation free,portable,guide pleural sampling Limited field of view Computed tomography Excellent resolution, high sensitivity, guide sampling Radiation,iodinated,relatively expensive Magnetic resonance imaging Radiation free,Accurate for lymphadenitis and associated spinal disease Expensive,CI,less accurate for parenchymal lesions PET CT/PET High sensitivity Low specificity,radiation exposure
  • 6. TYPICAL RADIOLOGRAPHIC PATTERN OF PRIMARY TUBERCULOSIS POST PRIMARY TUBERCULOSIS COMPLICATION OR SEQUEALE OF TB ATYPICAL PATTERNS
  • 7. Radiological Features of primary TB Lymphadenopathy Parenchymal consolidation Tuberculoma Miliary Tb Pleural Effusion Airway involvement Commonly in children Structure involved Lymphnode ,Pulmonary parenchyma ,pleura, Tracheobronchial tree
  • 8. 83-96% pediatric cases. 10-43% adults. m/c site Right paratracheal and Hilar region. WHY RIGHT SIDED? In a study -Subcarinal>hilar>anterior mediatinum> precarinal>Right paratracheal. B/L lymphadenopathy 31%cases CT higher sensitivity >CXR Lymphnode >1cm in SAD considered enlarged. LYMPHADENOPATHY
  • 9. Stage Of Lymphoid Hyperplasia Homogeneous Enhancement Stage Of Caseous Necrosis Heterogeneous Enhancement With Small Necrotic Area In Early stage Peripheral Thin Rim Enhancement With No Central Enhancement Stage Of Periadenitis Peripheral Irregular Enhancement With Central Non Enhancement with clear surrounding fat plane Stage Of Liquefaction Peripheral Rim Enhancement With Central Enhancement and obliterated surrounding fat plane pretracheal Hilar and subcarinal
  • 10. 1 Homogeneous Enhancement 2 Inhomogeneous with strong peripheral enhancement 3 No contrast enhancement Mediastinal and hilar lympahdenopathy Hilar and subcarinal
  • 11. Lymphnode +Draining lymphatics called Primary complex. Subpleural lesion-middle portion of lung Upper region of lower lobe, lower portion of middle lobe(Right side) PARENCHYMAL LESION
  • 12. GHONS focus +enlarged or calcified lymphnode.
  • 13. Small round/oval opacity in primary and postprimary tb Seen in 7-9% patients 0.5 to 4cm diametre seen commonly -Upperlobe right side Satellite lesion in 80 %cases
  • 14. Primarily seen in primary tb,although may be seen in post primary Innumerable 2mm or less non calcified nodules scatttered throughout lung Mild basilar preponderance. Coalesce -Snowstorm apparence(3-5mm) HRCT more sensitive .
  • 15. PLEURAL INVOLVEMENT IN TB PLEURAL EFFUSION Uncommon in primary TB Develops same side of initial TB Bilateral effusion 12% cases USG Pleural effusion can be quantified,evaluation of septations,sampling 10 ml
  • 16. Unilateral >90% cases Smallto moderate in size 10% case Large effusion CT more sensitive Pleural based nodules identified-Pseudotumour
  • 17. Enhancement of thickened inner visceral and outer parietal pleura with separation by pleural fluid SPLIT PLEURA SIGN TB EFFUSION fail to resolve Chronic suppurative form Fibrous scar tissue
  • 18. Occur in chronic cases Usually occur as result of fibrin deposition causing thickening ,adhesion and calcification.
  • 19. Can be extrinsic due to compression by enlarged lymphnode Lymphnode compression leads to atlectasis or hyperinflation. Occurs level of lobar bronchus or bronchus intermedius Anterior segment of UPPER LOBE OR MEDIAL SEGMENT OF MIDDLE LOBE Intrinsic by endobronchial spread
  • 20. FEATURES OF ACTIVE TB ON CT Centrilobular nodules Lobular consolidations Cavitations Bronchial wall thickening Necrotic mediastinal and hilar lympahdenopathy Pleural Effusion
  • 21. Predilection of apical and posterior segment of upper lobe superior segment of lower lobes Rarity of lymphadenopathy. Propensivity for calcification.
  • 22. Cavitation Local exudative lesion Local fibroproductive lesion Tuberculoma Bronchogenic spread Miliary tb Bronchostenosis Pleural disease
  • 23. m/c lesion focal or patchy heterogenous consolidation involving apical or posterior segment of UL or superior segment of LL Poorly defined Nodules Cavitation 45% cases Lobar or total lung consolidation.
  • 24. Healing replacement of TB granulation tissue by fibrous tissue Fluffy opacity well defined reticular and nodular opacity
  • 25. Occurs when area of caseation necrosis liquefies. Cavity in 40-45 % patients. Wall of cavity ----thin and smooth ----Nodular Air fluid level are uncommon in TB MYCETOMA intracavitary fungal ball
  • 26. occurs in 95% cases due to communication to tb cavity or intrabronchial rupture. TREE IN BUD appearance Acinar nodule-5mm
  • 27. Direct extension from adjacent parenchyma. Occurs due to cavitation,lymphnode erosion,hematogenous spread, extension due to the peribronchialregion. Sub mucosal site of infection Ulcerations Heals by fibrosis with circumferential stenosis
  • 28. Parenchymal Complication Airway Complication Pleural Complications Vascular Complications Mediastinal Complications Chest Wall Complications
  • 29. Can occur consequence of cicatrization of Previous active tb cavity after therapy sequeale of ARDS
  • 30. Ectatic bronchus or residual tb cavity colonised by Aspergillus species. CT-Mobile intracavitary nodule or mass surrounded By air
  • 31. Characterised by artitectural distortion,calcification Retraction of adjacent parenchyma
  • 32. Occur in severe TB MILIARY TB OR TB BRONCHOPNEUMONIA Predisposing factors-Malnutrition,Alcoholism,diabetes mellitus,Immunosuppressive therapy,HIV infection, Pregnancy
  • 33. BRONCHIECTASIS Due to destruction and fibrosis of lung parenchyma result in retraction and irreversible bronchial dilatation
  • 34. BRONCHOLITH BRONCHOSTENOSIS Endogenous Calcified material Chronic narrowing of bronchus
  • 36. Empyema communicate with bronchial tree by bpf and shows air fluid level
  • 38. Pseudoaneurysm Weakening of pulmonary artery wall by adjacent Cavitary TB AIR CRESCENT on cxr CTPA confirm diagnosis
  • 39. Soft tissue encasing major vessels and airway
  • 40. Pleural collection track exteriorly through chest wall
  • 41. Atypical findings Early stage-Typical post primary TB with upper lobe infiltrates Late stage-Noncavitatory,lower lobs infiltrates,Hilar adenopathy,pleural effusion
  • 42. Coexist with extensive pulmonary parenchymal or intrathoracic lymphnode infection. 10-20% have Normal Chest Xray
  • 43. Refers to imaginary horizontal line traced across hilum includes parahilar region. Includes middle lobe and lingula with lower lobes. Large cavities 3-4 cm. Pt receiving corticosteroids Hepatic /Renal disease DM Pregnancy HIV
  • 44. Silicosis-Pneumoconiosis caused by inhalation of silica Coexistance of TB AND SILICOSIS called silicotuberculosis 3-7% increased incidence of TB in person with silicosis.
  • 46. Primary TB M/C form in children Lymphadenopathy mayb only feature in primary TB Cavity less common in children
  • 48. Newer imaging modality Quantifiable-Amount of radiation depends on rate of metabolic activity Non invasive Appear as focal increase in FDG uptake Can detect early response of treatment by quantitative reduction in FDG uptake.