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The Radiology of Tuberculosis
Ronald J. Karpick, M.D.
Fairfax County Health Department
9/15/09
New England TB Intensive
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Fairfax County, VA
Population 10.5 Million
400 square miles
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The Nations Capitol is 9.6 miles from my office
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Today’s Objectives
• Learn how Radiation is produced and how
much an individual receives during a CXR
• Learn the major landmarks of the CXR
• Learn to distinguish Primary and Post
primary Pulmonary TB on the CXR
• Review the appearance of TB infection in
other organ systems
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Lead Shield X-ray tubeFilm
Posterior-Anterior (PA) Chest X-ray
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Grant’s Atlas of Anatomy 11th Ed
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F.J. Netter, Respiratory System, Ciba
Collection, 1980
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F.J. Netter, Respiratory System, Ciba Collection, 1980
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Primary Tuberculosis
• First infection with M. tuberculosis
• Most commonly by way of inhaled air
• Primary or Ghon focus
• Lymphatic spread
• Hematogenous spread
• Development of Delayed Hypersensitivity and Cell Mediated Immunity within 8 weeks
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Ghon
focus
a calcified
granuloma
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Ghon focus and enlarged
ipsilateral LN=Ranke
Complex/Ghon Complex
Primary TB
FJC 2.1
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FJC 2.9a
PRIMARY TB
MEDIASTINAL AND HILAR LN
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Right Hilar
LN
Subcarinal
LN
CAT Scan w Contrast
L
post
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PET Scan
Positive
Emission
Tomography
Radiolabeled
Glucose
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FJC 2.11PRIMARY TB, LN & INFILTRATE
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FJC 2.4
PRIMARY TB
CONSOLIDATED RIGHT UPPER
LOBE, NO AIR BRONCHOGRAMS
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FJC 2.12
PRIMARY TB-PLEURAL EFFUSION
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Pleural Effusion pushing mediastinum to the left
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Primary Tuberculosis
in adolescents and
young adults
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Post-Primary or Reactivation TB
• Reactivation of a previously dormant primary infection, though in a small number of cases, it is the extension of the primary infection if it occurs within a year of the initial infection.
• It is a disease of adolescents and adults
• It affects primarily the upper lobes with a propensity to cavitate,
• Extra pulmonary sites include the LN, Pleura, bone, CNS, GU, Peritoneum
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FJC 2.13a
POST PRIMARY or REACTIVATION
TUBERCULOSIS
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FJC 2.16
REACTIVATION TB WITH RUL CAVITY
AND BRONCHIAL SPREAD TO THE
LEFT LUNG
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Tree-in-Bud
appearance
Tree-in-bud appearance of TB
in a High Resolution CAT
scan
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Respiratory
bronchiole
Alveolar duct
Eisenhuber, Radiology 2002;222:771-72
Tree-in-Bud
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Dense calcification
in Right Upper
Lobe
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Post Primary Tuberculosis
Reactivation TB
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Miliary Tuberculosis
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Miliary Tuberculosis
CAT Scan
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CENTRAL NERVOUS SYSTEM
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Infiltrating process
MRI
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Infiltrating process with pressure
compressing the brain
edema
Tuberculosis
mass
CAT Scan
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Tuberculomas in the Brain
MRI
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TB Meningitis on cortex and Sylvian
fissure, MRI with contrast
R
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Collapsed
Vertebrae
Spinal Cord
MRI
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TB Osteomyelitis (Pott’s Disease)
CAT scan with contrast
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Moore &
Rafii,Radiol.Cl.
N.A 2001;39(2):
336
TB of the
head of
the Femur
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TB of the
Head and
Neck of
the
Femur
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Tuberculosis Arthritis of
the knee
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Moore &
Rafii,Radiol.Cl
.N.A
2001;39(2):
336
TB of the
Elbow
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Gastrointestinal TB
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Mixed
ulcero-
hypertro-
phic
M. Tb of the colon
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12-7-07
CAT Scan with contrast
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HIV +, liver and SpleenTW
CAT scan with Contrast
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Peripheral Lymph Node
Tuberculosis
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3-27-09
Lymph
Node
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Genital-Urinary TB
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Water Bottle Heart
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Today’s Objectives
• Learned how Radiation is produced and how much an individual receives during a CXR
• Learned the major landmarks of the CXR
• Learned to distinguish Primary and Post primary Pulmonary TB on the CXR
• Reviewed the appearance of TB infection in other organ systems
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References
• Radiographic Manifestations of Tuberculosis, 2nd
Ed., Daley et al., 2006, Francis J. Curry National Tuberculosis Center
• Diagnosis of Diseases of the Chest, Fraser & Pare’ WB Saunders, 1970
• Tuberculosis from Head to Toe, Harisinghani et al., RadioGraphics 2000; 20: 449-470
• Introduction to Chest Radiology; SB Gay et al., UVA Health Science Center, Department of Radiology, 2003
www.med-ed.virginia.edu/courses/rad/
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References
• Atlas Radiologic Anatomy; L.Wicke, 7th English
Edition, Icon Learning Systems, 2004
• Blueprints Radiology; A. Uzelac and RW Davis,
Lippincott Williams & Wilkins, 2006
• Introduction to Diagnostic Imaging; G. Stimac,
WB Saunders 1992
• Getting Started in Clinical Radiology; G. Eastman,
Wald and Crossin, Thieme, 2006