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

Abstract

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.

Tuberculose pulmonar: achados na tomografia computadorizada de alta resolução do tórax em pacientes com doença em atividade comprovada bacteriologicamente

“…Contudo, em virtude de a baciloscopia de escarro poder ser negativa em 21 a 66% dos casos, a cultura do mesmo poder levar até seis semanas para o crescimento de colônias e os achados nas radiografias de tórax serem freqüentemente classificados como indeterminados, o diagnóstico de atividade pode ser difícil (4)(5)(6) .…”

Aspectos tomográficos da tuberculose pulmonar em pacientes adultos com AIDS

“…In HIV-positive patients, lymph node enlargement may present peripheral contrast medium uptake, which is radiologically translated into a hypodense center and peripheral enhancement (21,24) . The study developed by Im et al (15) reports that the hypodense area corresponds to necrosis, and the peripheral enhancement of the lymph node enlargement limits results from the hypervascularization secondary to the inflammatory process. In the present 45-case study, 68.8% of the patients presented mediastinal or mediastinal/hilar lymph node enlargement, while hypodensity in lymph node areas after intravenous contrast injection was observed in seven cases (15%).…”

“…Such finding was the third most frequently observed in the present study (57.7%) but with no statistically significant difference between patients with CD4 count < 200 cel/mm 3 or CD4 count ≥ 200 cel/mm 3 . Im et al (15) , in a study with 41 immunosuppressed patients with pulmonary tuberculosis, have documented that the centrilobular lesion results from bronchogenic dissemination and that this was the most common finding in active disease, occurring in 95% of their patients. In the present study, the authors could observe that the frequency of parenchymal consolidation was significantly higher in patients with CD4 count ≥ 200 cel/mm 3 .…”

“…2011 Jan/Fev;44(1): [13][14][15][16][17][18][19] (34.3%) of the 35 patients presented ill defined nodules with centrilobular distribution, and 4 (40%) of the 10 patients presented such tomographic finding.…”

“…Lee Radiol Bras. 2011 Jan/Fev;44(1): [13][14][15][16][17][18][19] et al (12) have investigated the usefulness of computed tomography (CT) in the differentiation between active and inactive tuberculosis. Pereira et al (13) have described the tomographic findings of primary pulmonary tuberculosis initially manifested as lobar consolidation.…”