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      Chest tuberculosis: Radiological review and imaging recommendations

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          Abstract

          Chest tuberculosis (CTB) is a widespread problem, especially in our country where it is one of the leading causes of mortality. The article reviews the imaging findings in CTB on various modalities. We also attempt to categorize the findings into those definitive for active TB, indeterminate for disease activity, and those indicating healed TB. Though various radiological modalities are widely used in evaluation of such patients, no imaging guidelines exist for the use of these modalities in diagnosis and follow-up. Consequently, imaging is not optimally utilized and patients are often unnecessarily subjected to repeated CT examinations, which is undesirable. Based on the available literature and our experience, we propose certain recommendations delineating the role of imaging in the diagnosis and follow-up of such patients. The authors recognize that this is an evolving field and there may be future revisions depending on emergence of new evidence.

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          Most cited references53

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          Pulmonary tuberculosis: CT findings--early active disease and sequential change with antituberculous therapy.

          To evaluate findings of active pulmonary tuberculosis on computed tomographic (CT) scans and their sequential changes before and after antituberculous chemotherapy, 29 patients with newly diagnosed pulmonary tuberculosis and 12 patients with recent reactivation were studied prospectively. The diagnosis of active pulmonary tuberculosis was based on positive acid-fast bacilli in sputum (n = 29) and changes on serial radiographs obtained during treatment (n = 12). Twenty-six patients were followed up with CT during treatment for 1-20 months. Lungs from the cadavers of nine other patients, who died of pulmonary tuberculosis, were studied to provide a pathologic basis for diagnosis. At examination with CT, centrilobular lesions (nodules or branching linear structures 2-4 mm in diameter) were most commonly seen (n = 39 [95%]); in the 26 patients with follow-up, most of these lesions disappeared within 5 months after the start of treatment. In 11 of 12 patients with recent reactivation, CT clearly differentiated old fibrotic lesions from new active lesions. Lesions in and around the small airways appear to be the most characteristic CT feature of early active tuberculosis and may be a reliable criterion for disease activity.
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            Pulmonary tuberculosis: up-to-date imaging and management.

            S Lee, A Jeong (2008)
            Pulmonary tuberculosis (TB) is a common worldwide infection and a medical and social problem causing high mortality and morbidity, especially in developing countries. The traditional imaging concept of primary and reactivation TB has been recently challenged, and radiologic features depend on the level of host immunity rather than the elapsed time after the infection. We aimed to elaborate the new concept of the diagnosis and treatment of pulmonary TB, to review the characteristic imaging findings of various forms of pulmonary TB, and to assess the role of CT in the diagnosis and management of pulmonary TB. Fast and more accurate TB testing such as bacterial DNA fingerprinting and whole-blood interferon-gamma assay has been developed. Miliary or disseminated primary pattern or atypical manifestations of pulmonary TB are common in patients with impaired immunity. CT plays an important role in the detection of TB in patients in whom the chest radiograph is normal or inconclusive, in the determination of disease activity, in the detection of complication, and in the management of TB by providing a roadmap for surgical treatment planning. PET scans using 18F-FDG or 11C-choline can sometimes help differentiate tuberculous granuloma from lung malignancy.
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              Tuberculous pleural effusion.

              Tuberculous pleural effusion is one of the most common forms of extrapulmonary tuberculosis (TB). The immediate cause of the effusion is a delayed hypersensitivity response to mycobacterial antigens in the pleural space. For this reason microbiological analyses are often negative and limited by the lengthy delay in obtaining results. In areas with high TB prevalence, pleural fluid adenosine deaminase (ADA) levels greater than 40 U/l argue strongly for TB; in contrast, low levels of pleural ADA have high negative predictive value in low-prevalence countries. The specificity of this enzyme increases if only lymphocytic exudates are considered. The shortcoming of the ADA test is its inability to provide culture and drug sensitivity information, which is paramount in countries with a high degree of resistance to anti-TB drugs. Sputum induction (in addition to pleural fluid) for acid-fast bacilli and culture is a recommended procedure in all patients with TB pleurisy. The microscopic-observation drug-susceptibility assay performed on pleural fluid or pleural tissue increases by two to three times the detection of TB over conventional cultures, and it allows for the identification of multidrug-resistant TB. A reasonable management strategy for pleural TB would be to initiate a four-drug regimen and perform a therapeutic thoracentesis in patients with large, symptomatic effusions.
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                Author and article information

                Journal
                Indian J Radiol Imaging
                Indian J Radiol Imaging
                IJRI
                The Indian Journal of Radiology & Imaging
                Medknow Publications & Media Pvt Ltd (India )
                0971-3026
                1998-3808
                Jul-Sep 2015
                : 25
                : 3
                : 213-225
                Affiliations
                [1]Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
                [1 ]Department of Pulmonary Medicine, All India Institute of Medical Sciences, New Delhi, India
                Author notes
                Correspondence: Dr. Ashu Seith Bhalla, Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110029, India. E-mail: ashubhalla1@ 123456yahoo.com
                Article
                IJRI-25-213
                10.4103/0971-3026.161431
                4531444
                26288514
                f1e23152-1eb6-4aa9-827d-9811445756e3
                Copyright: © Indian Journal of Radiology and Imaging

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Chest Radiology

                Radiology & Imaging
                chest radiograph,chest tuberculosis (pulmonary,nodal and pleural),computed tomography,imaging recommendations,tb active

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