RADIOGRAPHIC MANIFESTATIONS OF

PULMONARY TUBERCULOSIS

DR. HASNA .N.

CAUSE AND
TRANSMISSION OF
TUBERCULOSIS AND
PROGRESSION OF
LATENT INFECTION
Radiological 1. Typical radiological patterns of primary TB.
patterns
may be
considered
under the 2. Post primary TB or Reactivation TB.
following
groups:
3. Patterns encountered in both primary and/or
postprimary TB.
4. Complications and sequelae of TB.
PRIMARY
TB
• The most common
abnormality in children is
lymph node
enlargement, which is
seen in 90–95% of cases.
• 10-year-old child
with tuberculosis,
shows widening of
the right
paratracheal stripe
CECT show tuberculous nodes
that show central areas of low
attenuation suggestive of
caseous necrosis and peripheral
rim enhancement
GHON
FOCUS
• Ghon focus may be visualized on
the chest radiograph as an airspace
opacity
GHON
LESION/FOCUS
• Small tan-yellow subpleural
granuloma in the mid-lung field on
the right.
• Over time, the granulomas decrease
in size and can calcify, leaving a focal
calcified spot on a chest radiograph
that suggests remote granulomatous
disease.
GHON
COMPLEX
• typical of primary
tuberculosis in a child
• Parenchymal involvement is
more in adults.
RANKE
COMPLEX
• The combination of calcific lesions
of the lung and lymph node is
referred to as the “Ranke complex”
• Airspace consolidation is usually
unilateral, is evident radiographically
in approximately 70% of children
with primary TB
• obtained at level of right middle lobar
bronchus
PLEURAL EFFUSION IN
TB
Pleural effusion is usually
unilateral and due to
subpleural infection.

Pleural effusions are more

common in adults with
primary tuberculosis (40%).
(ATELECTASIS
) VOLUME
LOSS
shows a right upper lobe airspace
opacity adjacent to the trachea.
In addition, there is
elevation of the minor fissure
(arrows),
 POST-PRIMARY
TUBERCULOSI
S
• focal or patchy
heterogeneous consolidation
involving the apicoposterior
segments of the upper lobes
and the superior segments of
the lower lobes
• lateral view of the same
patient, the typical location of
the apicoposterior segment
POST-PRIMARY TUBERCULOSIS/REACTIVATION
TUBERCULOSIS

• Predilection for upper

Post-primary
tuberculosis lobes
distinguishing • Lack of
features
lymphadenopathy
• Propensity for
cavitation
• The predilection for the upper lobes is thought to be due to
decreased lymph flow in the upper regions of the lung.

• An alternative explanation is the presence of higher oxygen

tension in that region.
 CAVITATI
ON
• Xray showing cavitatory
consolidation in right upper lung
zone and multiple ill-defined
nodules in both lungs
Cavitation and tree in bud sign is indicative of an active
disease process and usually heals as a linear or fibrotic
lesion.
MILIARY
TUBERCULO
SIS
Miliary TB refers to
widespread
dissemination of TB by
hematogenous spread.

Seen more frequently in

reactivation TB
Seen in pts with
Location
The characteristic
radiographic and high
resolution CT findings
consist of innumerable,
1- to 3-mm diameter
nodules randomly
distributed throughout
both lungs
chest radiograph shows
innumerable millet-sized
nodular opacities and
ground-glass opacities in
both lungs
 TUBERCULOM
A

Sequelae of healed primary TB, but

may be seen in 3–6 percent of cases of
postprimary tuberculosis as the main
or only abnormality
 HEALED TB

calcified nodule consistent

with a calcified
granuloma. In addition,
there is bilateral apical
pleural thickening
COMPLICATIONS AND
SEQUELAE
ASPERGILLOMA

tuberculous cavity
can be colonized by
Aspergillus species
and present as an
“aspergilloma”
spherical nodule or a mass
separated by a crescent-
shaped area of decreased
opacity or air from the
adjacent cavity wall
BRONCHIECTASIS

Bronchiectasis is seen in 30%–60% of patients with active postprimary

tuberculosis and in 71%–86% of patients with inactive disease at high-
resolution CT
HRCT shows traction
bronchiectasis in
the right upper lobe
TUBERCULOUS
EMPYEMA
This case demonstrates
a left pleural effusion with air-fluid
levels consistent with a
hydropneumothorax caused by the
bronchopleural fistula.
Diagnosis of hydropneumothorax is
based on the presence of a pleural
effusion accompanied by an air-fluid
level within the pleural space.
BRONCHOPLEURAL
FISTULA
Empyema may also communicate with the
bronchial tree by bronchopleural fistula
and can show an air fluid level
VASCULAR
COMPLICATIONS
Bronchial arteries
may be enlarged in bronchiectasis associated
with TB
RASMUSSEN
ANEURYSM
Rasmussen aneurysm is a
pseudoaneurysm that results from
weakening of the pulmonary artery
wall by adjacent cavitatory TB
CECT obtained shows cavitatory
consolidation
with air-crescent sign in left
upper lobe.
PNEUMOTHORA
X
Pneumothorax occurs in
approximately 5 percent of
patients with postprimary TB,
usually in severe cavitatory
disease.
PLEURAL
EMPYEMA
Bacilli can enter the pleural space
from a juxtapleural caseating
granuloma, or via hematogenous
dissemination
TRACHEOBRONC
HIAL STENOSIS
BRONCHOLI
TH
PERICARDITI
S
Tuberculous pericarditis
reported to complicate 1
percent
of cases of TB is commonly
caused by extranodal
extension of tuberculous
adenitis into the pericardium
TUBERCULOSIS
AND HIV
• As the CD4 lymphocyte count declines, the radiographic
findings look more like those seen in primary disease.
• The radiographic opacities may be in the lower lung zones
and multilobar in nature.
• Lymphadenopathy is more common.
THANK
YOU