-Dr. Prof. TITO’s Unit

Dr. Pandichelvan R.

-Most commonly manifest as post primary TB rather than Primary TB in older patients

-Purely Nodular Pattern in febrile patient with acute presentation suggestive of hematogenous infection, particularly miliary TB.

-Radiological evidence usually takes several weeks to appear.

MILIARY TUBERCULOSIS

Imaging FindingsDiscrete Distinctive Pin-point opacities WHY NODULARITY?

Nodule size 1 – 2 mm in diameter -SPHERICAL LESION IN

Miliary ( millet seed ) Pattern INTERSTITIUM

B/L even distribution -WELL CIRCUMSCRIBED

Basal Predominance HOMOGENOUS PATTERN

Rare or non-existent calcifications

Upto 30 % no radiological signs

Thickening of intralobar fissure / interlobular septa

Nodular irregularity of vessels

HRCT – more sensitive

Differential diagnosisPNEUMOCONIOSIS

- Coal Workers Pneumoconiosis- Silicosis- Siderosis- Stannosis

SARCOIDOSIS

METASTATIC LUNG DISEASES

NON TB INFECTIONS- Histoplasmosis- Blastomycosis- Cryptococcosis- Nocardiosis- Coccidiodomycosis

BRONCHIOLITIS OBLITERANS

SILICOSIS :

Multiple well circumscribed nodules

Uniform density

Upper lobe predominance

Mainly posterior lobe

Nodular Calcification seen in 10 – 20 % cases

Hilar lymphadenopathy

Egg Shell Calcification

:

COAL WORKERS PNEUMOCONIOSIS:

Simple Pneumoconiosis

small round nodule 1 – 5mm

granular densities

calcifications begin as central dot

Complicated Pneumoconiosis

large opacities > 1cm

upper lung zones

start peripherally

Metastatic Lung Disease75% -multiple pulmonary nodules

B/L with basal predominance

peripheral lesions ( subpleural )

cavitatory lesions

squamous carcinomas

sarcomas

calcification rare ,except in

osteogenic sarcoma

chondrosarcoma

mucinous adenocarcinoma

SARCOIDOSISB/L symmetrical diffuse pulmonary

disease

B/L Hilar lymphadenopathy

Upper zone mainly

Imaging Patterns:

m/c nodular

reticulo-nodular

reticular pattern

(rare) air space consolidaton

ground glass opacification