Tuberculosis

Is a highly contagious disease caused by a bacteria known as Mycobacterium tuberculosis. Generally affects the lungs, but it also can invade other organs of the body, like the brain, kidneys and lymphatic system. Characterized by the growth of nodules (tubercles) in the tissues, especially the lungs

The Importance of Chest X-Ray

The chest radiograph is not considered as the gold standard and has limited role in the diagnosis of smear positive pulmonary tuberculosis . Its use is recommended for diagnosis of smear negative pulmonary tuberculosis for difficult cases.
Repeat X-ray chest if done more than two weeks back or if x-ray chest is not available. Always ask for previous X- rays. Always examine the serial x-rays.

Normal Chest X - Ray

Location

In majority of cases, pulmonary tuberculosis manifests itself by presenting radiological signs limited to the upper zones. Chest X- ray can be divided into three radiological zones.

Upper zone - up to lower margin of 2nd rib

Mid zone - from lower margin of 2nd rib

to lower margin of 4th rib Lower zone - from 4th rib to diaphragm

PA VIEW

The PA chest-film it is important to examine all the areas where the lung borders the diaphragm, the heart and other mediastinal structures. At these borders lung-soft tissue interfaces are seen resulting in a:

Line or stripe - for instance the right para tracheal stripe.

Silhouette - for instance the normal silhouette of the aortic knob or left ventricle These lines and silhouettes are useful localizers of disease, because they can be displaced or obscured with loss of the normal silhouette. Widening of the paratracheal line (> 23mm) may be due to lymphadenopathy, pleural thickening, hemorrhage or fluid overload and heart failure. Displacement of the para-aortic line can be due to elongation of the aorta, aneurysm, dissection and rupture.

NORMAL APICAL VIEW

Indications for imaging To clarify anomaly seen on PA projection: ex. Interlobular effusion, Pancoast tumour superior pulmonary sulcus tumor an adenocarcinoma of a lung apex Anatomy Demonstrated Lung apices and the medial ends of the first 4 ribs

Lateral view

The retrosternal space should be radiolucent, since it only contains air. Any radiopacity in this area is suspective of a proces in the anterior mediastinum or upper lobes of the lung. The contours of the left and right diaphragm should be visible. The right diaphragm should be visible all the way to the anterior chest wall (red arrow). The left diaphragm can only be seen to a point where it borders the heart
o

Here the interface is lost, since the heart has the same density as the structures below the diaphragm.

PRIMARY PTB

Primary TB pneumonia attacks people who are:

weaker immune

systems young children elderly are most at risk those with HIV/AIDS.

Apical View

This type of TB is uncommon and attacks the lungs in the form of pneumonia with symptoms of high fever and cough.

PA VIEW

Latereal view

Primary TB

Unilateral hilar or mediastinal lymph node enlargement, particularly in children, and may be the sole radiographic manifestation of infection
The radiographic presentation may include focal air-space opacity or an isolated pleural effusion. The parenchymal lesion is often located in the lower lobes. Lymphatic spread to regional lymph nodes may produce adenopathy. The combination of a calcified parenchymal opacity (the Ghon lesion) and ipsilateral hilar adenopathy is referred to as the Ranke complex

POST PRIMARY TB

Reactivation TB or secondary TB This develops in the

posterior segments of the upper lobes superior segments of the lower lobes.

Post-primary infections are far more likely to cavitate than primary infections. Lobar consolidation, tuberculoma formation and miliary TB are also recognized patterns of postprimary TB but are less common. Tuberculomas account for only 5% of cases of post-primary TB

APICAL VIEW

appear as a well defined rounded mass typically located in the upper lobes single and measure up to 4 cm in size

Post Primary TB

Cavitation is an important radiographic feature of postprimary infection and usually indicates active and transmissible disease

Erosion of a cavitary focus into a branch of the pulmonary artery can produce an aneurysm (Rasmussen aneurysm) and cause hemoptysis.

Milliary TB

Miliary TB is diagnosed when small granules appear in the lungs. Miliary TB may complicate either primary or reactivation disease. It results from hematogenous dissemination of tubercle bacilli and produces diffuse bilateral 2- to 3-mm pulmonary nodules

Miliary TB
micronodular opacities characteristic of micronodular (miliary) interstitial disease.

On chest radiograph, consisting of innumerable tiny opacities throughout the lung . Cavitary lesions may become secondarily superinfected by aspergillus, producing a fungus ball or mycetoma. the infection may erode into pulmonary arteries, producing massive hemoptysis.