Rontgenologies of Tuberculosis in Children

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Normal Rontgenography

Normal CXR

Normal Adult CXR

Male Female

Normal Ro in Children

Kunci : para hiler & infrahiler bersih

Right Lateral
TB Normal

Infrahilar adenopathy Lurus. bersih

1st Pulmonary Tuberculosis

Patterns
Pneumonia Lymphadenopathy Atelectasis Pleural effusion

Looking for TB Rontgenologis in Children

Should be :
Antero-Posterior, Right Lateral

AND

Ghon focus

Primary Tuberculosis Pneumonia

Upper lobes affected slightly more than lower Pneumonia common Cavitation is rare Lobar pneumonia almost always associated with lymphadenopathy Infiltrate + ipsilateral adenopathy : think TB

Primary Tuberculosis Adenopathy

Unilateral hilar and / or paratracheal Usually right-sided Rarely bilateral Differentiates 1 from 2 does not occur in post primary TB Adenopathy much more common in children

Lymphadenopathy

Lymphadenopathy

Lymphadenopathy

Lymphadenopathy

Buntu

Lymphadenopathy

Lymphadenopathy

Primary Tuberculosis Atelectasis Classically affects anterior segments of upper lobes, or

Medial segment of the RML

Pleural Effusion

Pleural Effusion

Primary Tuberculosis General

Calcification in 1

complex is relatively rare Few patients with 1 TB have clinical manifestations

Post primary Tuberculosis Reactivation TB

Reactivation TB General
Most cases in adults occur as reactivation of 1 focus of infection acquired in childhood Caseous necrosis & tubercle are pathologic hallmarks of post 1 TB Tubercle = accumulations of mononuclear macrophages, Langhans giant cells surrounded by lymphocytes / fibroblasts

Reactivation TB General
Healing occurs with fibrosis and contraction Calcification is rarer than in 1 Limited mainly to apical & posterior segments of upper lobes & superior segments of lower lobe

Reactivation TB Patterns
Pneumonia Cavity formation Transbronchial spread Bronchiectasis Bronchostenosis Pleural disease Tuberculoma Bone involvement

Cavity

Cavity

Cavity

Reactivation TB Patterns
Affects apical or posterior segments of upper lobes or superior segments of lower lobes Bilateral upper lobe disease is very common May present as pneumonia Cavitation may result Cavity is usually thin-walled, smooth on inner margin with no air-fluid level

Reactivation TB Patterns

Reactivation TB Patterns

Reactivation TB Patterns
Transbronchial spread may occurfrom one upper lobe to opposite lower Bronchiectasisusually asymptomatic Bronchostenosis due to fibrosis and stricture Fibrosis may cause distortion of a bronchus and atelectasis many years after initial infection = middle lobe syndrome

Middle Lobe Syndromes

=Middle

Lobe Atelectasis + Hilar Lymphadenopathy

Reactivation TB Patterns
Pleural effusion in postprimary TB Almost always means direct spread of disease in to pleural cavity Should be regarded as an empyema Carries a graver prognosis than effusion of 1 form Direct extension into ribs or sternoclavicular joints is uncommon

Reactivation TB Patterns
Solitary pulmonary nodule Tuberculoma May occur in either 1 or postprimary disease Round or oval lesions with small, discrete shadows in immediate vicinity of lesion=satellite lesion

Miliary Tuberculosis

Miliary Tuberculosis General

Hematogenous dissemination of bacilli

common in 1 TB but clinically evident miliary TB rarely occurs May not manifest itself for many years after infection

Miliary Tuberculosis General

Miliary Tuberculosis Clinical

Older men, Blacks and pregnant women susceptible Onset is insidious Fever, chills, night sweats are common Takes weeks between time of dissemination and radiographic appearance of disease

Miliary TB Natural History

When 1st visible, measure about 1 mm in size Frequently missed on first films Can grow to 2-3mm if left untreated When treated, clearing is rapid Miliary TB does NOT heal with calcification

Calcification in TB 3 Funny Names

1. Ghon lesion = calcified granuloma

2. Ranke complex = Ghon lesion + calcified

lymph node
3. Simon focus = healed site of 1

infection at lung apex

Ghons Complex
Ghons complex Complicated Ghon Focus

Calcification

TB and Other Diseases

Occurs with a higher incidence in sarcoidespecially if rx with steroids Associated with silicosis Associated with HIV infection No relationship with bronchogenic Ca

TB and AIDS
Mycobacterium avium-intracellulare (MAI) is more common than TB TB in AIDS looks like 1 form Hilar and mediastinal adenopathy common Cavitation less common No predilection for apices

TB : The Question of Activity

Only serial images with no change can suggest lack of activity2 years In presence of cavities, activity must be determined clinically

Tuberculosis Ancient Remedies

Rest Theory

Ping-pong ball plumbage Paraffin plumbage Oleothorax Pneumothorax and pneumoperitoneum Thoracoplasty

Thank You