Fact-sheet: Lung or pleural tuberculosis
Updated on 07/29/2022 at 5:13 PM
View all RADEOS cases associated with this fact-sheet
Definition
Pathogen: Mycobacterium tuberculosis = Koch's bacillus.
Risk factors:
- HIV
- immunosuppressive treatment, prolonged corticosteroid therapy, anti-TNFα
- socioeconomic hardship
- originating from a country of high endemicity.
Primary pulmonary infection:
formation of the Ranke ganglio-parenchymal complex,
evolves in 90% of cases (70% in the immunocompromised) toward healing.
Tuberculosis disease: after a more or less prolonged latency period
Clinical features
Background (see risk factors)
- Primary infection: most often asymptomatic
OR flu-like syndrome, general deterioration, erythema nodosum
- Tuberculosis disease:
cough, expectoration, dyspnea,
general deterioration,
evening fever and night sweats
CT
PRIMARY TUBERCULOUS INFECTION
- Parenchymal consolidations: homogeneous consolidation of the upper lobes, or of the middle lobe; related to the confluence of granulomas
- Tuberculous lymphadenitis ++:
- observed in 90 to 95% of cases in children
- most often right paratracheal adenomegaly
- lymph node with central lucency, peripheral enhancement
- Healing in the form of calcifications
- Pleural effusion: evolution toward fibrosis and calcification (residual pachypleuritis)
- Miliary pattern: diffuse micronodules of random distribution (hematogenous route)
TUBERCULOSIS DISEASE
- Parenchymal consolidations: upper lobes or Fowler's position, often bilateral
- Cavities +++: often multiple, +/- air-fluid level suggestive of superinfection
DDx: lung abscess, abscessed cancer, or metastasis
- cystic lesions
- Endobronchial tuberculosis: - Tree-in-bud pattern: centrilobular micronodules > indicates active infection
- Bronchial stenoses and bronchiectasis
- Miliary pattern
