Chest computed tomography is more likely to show latent tuberculosis foci than simple chest radiography in liver transplant candidates

Abstract

Although the detection and treatment of latent tuberculosis infections (LTBIs) in transplant candidates are essential, current diagnostic methods for LTBIs are limited, especially in immunocompromised subjects. Pretransplant chest computed tomography (CT) may reveal more LTBI foci and thus predict the development of posttransplant tuberculosis (TB) more efficiently; however, this hypothesis has not yet been investigated. Thirty-six liver transplantation (LT) recipients who developed TB (the TB group) and 144 LT recipients who did not develop TB (the control group) were retrospectively enrolled into a study with a nested case-control design, and their clinical characteristics and radiological findings were compared. Tuberculin skin tests (TSTs) were not performed, and none of these patients had been treated for LTBIs. Thirty-six of 2549 LT recipients (1.4%) were diagnosed with TB after LT (median ¼ 10 months, range ¼ 1-80 months). Twenty-eight patients (77.8%) successfully completed the treatment. There were no significant differences in the clinical characteristics of the 2 groups. Abnormal CT findings (40.0% versus 17.3%, P ¼ 0.018) and chest X-ray (CXR) findings (25.0% versus 11.8%, P ¼ 0.044) suggestive of healed TB were significantly more frequent in the TB group versus the control group. Of the 10 patients who underwent chest CT and developed TB, 5 (50%) showed abnormal findings only on chest CT scans, whereas their CXR results were normal. In conclusion, a pretransplant chest CT scan is more likely to show an LTBI than a CXR in those with post-LT TB. The usefulness of chest CT along with traditional methods such as TSTs for LTBI screening should be further investigated. Liver Transpl 17:963-968, 2011. V C 2011 AASLD.

The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement

“…In cases where the pre-transplant screening may be falsely negative, as with anergy to TST or an indeterminate IGRA, specialised imaging may be employed in selected patients. Thoracic computed tomography (CT) scanning may be superior to chest radiography in assessing the risk of post-transplant TB [79]. Genitourinary studies may also be helpful in higher risk recipients.…”

Diagnostic Accuracy of Chest Radiography for the Diagnosis of Tuberculosis (TB) and Its Role in the Detection of Latent TB Infection: a Systematic Review

“…In a child in whom previous contact with TB is certain, the presence of positive TST and pathological CXR with or without symptoms suggests a diagnosis of TB. An increased risk for pulmonary TB is associated with findings such as a "tree-in-bud" appearance (indicative of endobronchial spread), lobular consolidation, and large nodules on CT scans 95,96 . In this context, the correct interpretation of CXR is a crucial requirement, and chest CT is recommended if CXR is equivocal 93 .…”

Lung tuberculosis in a patient suffering from granulomatosis with polyangiitis (Wegener's granulomatosis) and receiving immunosuppressive treatment

“…Jamy z grubymi ścianami występują w ropniu płuca, raku płaskonabłonkowym z martwicą i rozpadem, ziarniniakowatości z zapaleniem naczyń oraz aspergilozie. Bardziej precyzyjnym badaniem niż konwencjonalne badanie radiologiczne klatki piersiowej jest tomografia komputerowa, która może wykazać małe jamy, zmiany typu "pączkują-cego drzewa" i drobne guzki [12].…”