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Pulmonary Tuberculosis: The Essentials

¹ Department of Radiology, S-072A, Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5105.

View larger version (145K): [in a new window]   Figure 1a. Sputum culture–positive TB in an 82-year-old Asian woman. (a) Close-up radiographic view of right upper lobe shows an ill-defined area of increased opacity (arrow) associated with calcification in the retroclavicular region. (b) Corresponding thin-section CT scan obtained with 1-mm collimation shows nodular opacities containing foci of calcification (arrows) in the apical segment. The remainder of the thoracic CT study (not shown) obtained at 7 mm collimation revealed no other abnormalities that could account for the positive culture.

View larger version (154K): [in a new window]   Figure 1b. Sputum culture–positive TB in an 82-year-old Asian woman. (a) Close-up radiographic view of right upper lobe shows an ill-defined area of increased opacity (arrow) associated with calcification in the retroclavicular region. (b) Corresponding thin-section CT scan obtained with 1-mm collimation shows nodular opacities containing foci of calcification (arrows) in the apical segment. The remainder of the thoracic CT study (not shown) obtained at 7 mm collimation revealed no other abnormalities that could account for the positive culture.

View larger version (130K): [in a new window]   Figure 2. Chest radiograph obtained in a 4-year-old girl shows isolated left hilar lymphadenopathy (arrow) without associated parenchymal involvement.

View larger version (171K): [in a new window]   Figure 3. Chest radiograph obtained in a 4-year-old boy shows right hilar lymphadenopathy (arrow) associated with right upper lobe consolidation. Right paratracheal lymphadenopathy (not shown) was also present.

View larger version (111K): [in a new window]   Figure 4. Delayed thin-section CT scan obtained with 1-mm collimation after administration of intravenous contrast material in a 29-year-old Asian woman shows typical appearance of tuberculous lymphadenitis with central low attenuation and peripheral rim enhancement (arrows).

View larger version (144K): [in a new window]   Figure 5. Chest radiograph obtained in a 7-month-old Hispanic boy shows right paratracheal lymphadenopathy (straight arrow) with multilobar consolidation predominating in the right lung. Moderate right lower lobe atelectasis with inferior displacement of major fissure (curved arrows) is associated. Right hilar lymphadenopathy (not shown) was also present.

View larger version (142K): [in a new window]   Figure 6. Chest radiograph obtained in a 3-year-old Hispanic boy shows mediastinal and right hilar lymphadenopathy. Atelectasis of the right lower lobe is present with depression of the major fissure (arrows).

View larger version (159K): [in a new window]   Figure 7. Chest radiograph obtained in a 25-year-old Asian woman shows volume loss of the right lung with mediastinal shift to right. At bronchoscopy, severe stenosis of right main and upper lobe bronchi was identified.

View larger version (135K): [in a new window]   Figure 8. Chest radiograph obtained in a 19-year-old woman shows a large right-sided pleural effusion (curved arrows) associated with right hilar lymphadenopathy (straight arrows).

View larger version (167K): [in a new window]   Figure 9a. Atypical distribution of postprimary TB in a 62-year-old man. (a) Chest radiograph shows a 5-cm cavitary mass with a thick, irregular wall (large arrow) and surrounding adjacent nodular opacities in the left upper lobe. An ill-defined 5-mm nodule (small arrow) is present in the contralateral, right upper lobe. (b) CT scan obtained with 7-mm collimation shows the location of the cavitary mass (arrows) in the anterior segment of left upper lobe.

View larger version (149K): [in a new window]   Figure 9b. Atypical distribution of postprimary TB in a 62-year-old man. (a) Chest radiograph shows a 5-cm cavitary mass with a thick, irregular wall (large arrow) and surrounding adjacent nodular opacities in the left upper lobe. An ill-defined 5-mm nodule (small arrow) is present in the contralateral, right upper lobe. (b) CT scan obtained with 7-mm collimation shows the location of the cavitary mass (arrows) in the anterior segment of left upper lobe.

View larger version (98K): [in a new window]   Figure 10. Close-up radiographic view of the upper lung zones in a 56-year-old Hispanic man shows ill-defined parenchymal opacities (white arrows) associated with nodular and linear components in the periphery of the bilateral upper lobes. A loculated right pleural effusion (black arrows) is present.

View larger version (114K): [in a new window]   Figure 11. Targeted 1.5-mm-collimation CT scan of the left upper lobe in a 40-year-old woman shows an irregularly marginated, 2-cm tuberculoma (large arrow) demonstrating central cavitation and associated with small, adjacent nodules (small arrow).

View larger version (138K): [in a new window]   Figure 12. Chest radiograph obtained in a 39-year-old Asian man shows an air-fluid level (arrows) within an 8-cm cavitary mass located in the superior, lateral basal, and posterior basal segments of the right lower lobe.

View larger version (140K): [in a new window]   Figure 13a. Postprimary pattern of TB in a 54-year-old Hispanic man. (a) Radiograph obtained at presentation shows focal areas of confluent consolidation (large arrows) in the bilateral upper lobes. In the right lung, multiple ill-defined, 5–8-mm nodules (small arrows) can be identified; in the more severely affected left lung, a bronchopneumonia pattern is present predominating in the lower lobe. (b) Radiograph obtained 3 months after initiation of treatment shows that improvement has occurred, with resolution of right lung nodules. Reticulonodular opacities persist in bilateral upper and left lower lung zones.

View larger version (136K): [in a new window]   Figure 13b. Postprimary pattern of TB in a 54-year-old Hispanic man. (a) Radiograph obtained at presentation shows focal areas of confluent consolidation (large arrows) in the bilateral upper lobes. In the right lung, multiple ill-defined, 5–8-mm nodules (small arrows) can be identified; in the more severely affected left lung, a bronchopneumonia pattern is present predominating in the lower lobe. (b) Radiograph obtained 3 months after initiation of treatment shows that improvement has occurred, with resolution of right lung nodules. Reticulonodular opacities persist in bilateral upper and left lower lung zones.

View larger version (143K): [in a new window]   Figure 14. Thin-section CT scan obtained with 1-mm collimation in a 26-year-old Hispanic man shows multiple 2–4-mm centrilobular nodules and linear, branching opacities (arrows) in the superior segment of right lower lobe.

View larger version (112K): [in a new window]   Figure 15. CT scan obtained with 8-mm collimation in a 41-year-old man shows eccentric mural thickening (straight arrow) involving the proximal aspect of the medial segmental bronchus of the right middle lobe associated with endobronchial secretions (curved arrow) more distally. The patient's symptoms at presentation were a mild, non-productive cough with right-sided wheezing. Bronchial biopsy specimens contained areas of necrotizing granulomatous inflammation from which M tuberculosis was grown on culture.

View larger version (142K): [in a new window]   Figure 16a. Tuberculous empyema in a 77-year-old Asian man. (a) Seven-millimeter-collimation CT scan of the right upper lobe shows a 2-cm nodule (arrow) with central cavitation in the posterior subpleural region that was not detected at radiography. (b) Seven-millimeter-collimation contrast-enhanced CT scan obtained at the level of the superior segmental bronchus (curved arrow) shows a roughly elliptical fluid collection bordered by thickened and enhancing visceral and parietal pleura. The small amount of air (straight arrow) seen in the nondependent region indicates the presence of a bronchopleural fistula.

View larger version (148K): [in a new window]   Figure 16b. Tuberculous empyema in a 77-year-old Asian man. (a) Seven-millimeter-collimation CT scan of the right upper lobe shows a 2-cm nodule (arrow) with central cavitation in the posterior subpleural region that was not detected at radiography. (b) Seven-millimeter-collimation contrast-enhanced CT scan obtained at the level of the superior segmental bronchus (curved arrow) shows a roughly elliptical fluid collection bordered by thickened and enhancing visceral and parietal pleura. The small amount of air (straight arrow) seen in the nondependent region indicates the presence of a bronchopleural fistula.

View larger version (99K): [in a new window]   Figure 17. Close-up radiographic view of the right lung of a 35-year-old HIV-seropositive man shows innumerable, 1–3-mm nodules scattered diffusely through the lung parenchyma, with associated calcified right hilar nodes (arrow).

View larger version (138K): [in a new window]   Figure 18a. Miliary tuberculosis in a 27-year-old Asian woman. Thin-section CT scans obtained at 1-mm collimation and displayed at (a) lung and (b) mediastinal windows show innumerable, sharply marginated, 1–2-mm nodules in a diffuse and random distribution. The associated findings, which include an irregularly marginated right middle lobe tuberculoma (curved arrow), loculated right pleural effusion (open arrows), and internal mammary lymphadenopathy (straight arrow), suggest that miliary dissemination occurred as a result of primary TB.

View larger version (111K): [in a new window]   Figure 18b. Miliary tuberculosis in a 27-year-old Asian woman. Thin-section CT scans obtained at 1-mm collimation and displayed at (a) lung and (b) mediastinal windows show innumerable, sharply marginated, 1–2-mm nodules in a diffuse and random distribution. The associated findings, which include an irregularly marginated right middle lobe tuberculoma (curved arrow), loculated right pleural effusion (open arrows), and internal mammary lymphadenopathy (straight arrow), suggest that miliary dissemination occurred as a result of primary TB.

View larger version (132K): [in a new window]   Figure 19. Chest radiograph obtained in a 28-year-old HIV-seropositive man shows consolidation in the left upper lobe associated with mediastinal (double arrows) and left hilar (single arrow) lymphadenopathy.

View larger version (155K): [in a new window]   Figure 20a. Complications of childhood TB causing recurrent hemoptysis in a young black man. (a) Detailed radiographic view obtained when the patient was 28 years old shows a cavity (arrows) in the left upper lobe. (b) Eleven years later, detailed radiographic view shows development of a nodule (arrows) in the cavity. (c, d) Corresponding 8-mm-collimation, supine and 1-mm-collimation, prone CT scans show the dependency of the mobile fungus ball (solid arrow) relative to patient positioning. Bronchiectasis (open arrows) adjacent to the cavity and atelectasis of the left upper lobe are present.

View larger version (153K): [in a new window]   Figure 20b. Complications of childhood TB causing recurrent hemoptysis in a young black man. (a) Detailed radiographic view obtained when the patient was 28 years old shows a cavity (arrows) in the left upper lobe. (b) Eleven years later, detailed radiographic view shows development of a nodule (arrows) in the cavity. (c, d) Corresponding 8-mm-collimation, supine and 1-mm-collimation, prone CT scans show the dependency of the mobile fungus ball (solid arrow) relative to patient positioning. Bronchiectasis (open arrows) adjacent to the cavity and atelectasis of the left upper lobe are present.

View larger version (146K): [in a new window]   Figure 20c. Complications of childhood TB causing recurrent hemoptysis in a young black man. (a) Detailed radiographic view obtained when the patient was 28 years old shows a cavity (arrows) in the left upper lobe. (b) Eleven years later, detailed radiographic view shows development of a nodule (arrows) in the cavity. (c, d) Corresponding 8-mm-collimation, supine and 1-mm-collimation, prone CT scans show the dependency of the mobile fungus ball (solid arrow) relative to patient positioning. Bronchiectasis (open arrows) adjacent to the cavity and atelectasis of the left upper lobe are present.

View larger version (152K): [in a new window]   Figure 20d. Complications of childhood TB causing recurrent hemoptysis in a young black man. (a) Detailed radiographic view obtained when the patient was 28 years old shows a cavity (arrows) in the left upper lobe. (b) Eleven years later, detailed radiographic view shows development of a nodule (arrows) in the cavity. (c, d) Corresponding 8-mm-collimation, supine and 1-mm-collimation, prone CT scans show the dependency of the mobile fungus ball (solid arrow) relative to patient positioning. Bronchiectasis (open arrows) adjacent to the cavity and atelectasis of the left upper lobe are present.