New England TB Intensive

The Radiology of Tuberculosis

Ronald J. Karpick, M.D. Fairfax County Health Department 9/15/09

Fairfax County, VA
Population 10.5 Million 400 square miles

The Nations Capitol is 9.6 miles from my office

Todays Objectives
Learn how Radiation is produced and how much an individual receives during a CXR Learn the major landmarks of the CXR Learn to distinguish Primary and Post primary Pulmonary TB on the CXR Review the appearance of TB infection in other organ systems

Posterior-Anterior (PA) Chest X-ray

Film

Lead Shield

X-ray tube

Grants Atlas of Anatomy 11th Ed

F.J. Netter, Respiratory System, Ciba Collection, 1980

F.J. Netter, Respiratory System, Ciba Collection, 1980

Primary Tuberculosis
First infection with M. tuberculosis Most commonly by way of inhaled air Primary or Ghon focus Lymphatic spread Hematogenous spread Development of Delayed Hypersensitivity and Cell Mediated Immunity within 8 weeks

Ghon focus a calcified granuloma

Primary TB

Ghon focus and enlarged ipsilateral LN=Ranke Complex/Ghon Complex

FJC 2.1

PRIMARY TB
MEDIASTINAL AND HILAR LN
FJC 2.9a

CAT Scan w Contrast

Subcarinal LN

Right Hilar LN

post

PET Scan Positive Emission Tomography

Radiolabeled Glucose

PRIMARY TB, LN & INFILTRATE

FJC 2.11

PRIMARY TB
CONSOLIDATED RIGHT UPPER LOBE, NO AIR BRONCHOGRAMS
FJC 2.4

PRIMARY TB-PLEURAL EFFUSION

FJC 2.12

Pleural Effusion pushing mediastinum to the left

Primary Tuberculosis

in adolescents and young adults

Post-Primary or Reactivation TB
Reactivation of a previously dormant primary infection, though in a small number of cases, it is the extension of the primary infection if it occurs within a year of the initial infection. It is a disease of adolescents and adults It affects primarily the upper lobes with a propensity to cavitate, Extra pulmonary sites include the LN, Pleura, bone, CNS, GU, Peritoneum

POST PRIMARY or REACTIVATION TUBERCULOSIS

FJC 2.13a

REACTIVATION TB WITH RUL CAVITY AND BRONCHIAL SPREAD TO THE LEFT LUNG FJC 2.16

Tree-in-bud appearance of TB Tree-in-Bud in a High Resolution CAT appearance scan

Tree-in-Bud

Respiratory bronchiole

Alveolar duct

Eisenhuber, Radiology 2002;222:771-72

Dense calcification in Right Upper Lobe

Post Primary Tuberculosis Reactivation TB

Miliary Tuberculosis

CAT Scan

Miliary Tuberculosis

Millet seeds

CENTRAL NERVOUS SYSTEM

Infiltrating process

MRI

Infiltrating process with pressure compressing the brain

edema

Tuberculosis mass CAT Scan

Tuberculomas in the Brain

MRI

TB Meningitis on cortex and Sylvian fissure, MRI with contrast

Skeletonal TB

Anterior

Collapsed Vertebrae

Spinal Cord

MRI

Abscess

CAT scan with contrast

TB Osteomyelitis (Potts Disease)

TB of the head of the Femur

Moore & Rafii,Radiol.Cl. N.A 2001;39(2): 336

TB of the Head and Neck of the Femur

Tuberculosis Arthritis of the knee

TB of the Elbow
Moore & Rafii,Radiol.Cl .N.A 2001;39(2): 336

Gastrointestinal TB

M. Tb of the colon

Mixed ulcerohypertrophic

CAT Scan with contrast

12-7-07

CAT scan with Contrast

HIV +, liver and Spleen

TW

Peripheral Lymph Node Tuberculosis

Lymph Node

3-27-09

Genital-Urinary TB

Renal TB

IVP

TW

Pericardial TB

Water Bottle Heart

CAT Scan

Todays Objectives
Learned how Radiation is produced and how much an individual receives during a CXR Learned the major landmarks of the CXR Learned to distinguish Primary and Post primary Pulmonary TB on the CXR Reviewed the appearance of TB infection in other organ systems

References
Radiographic Manifestations of Tuberculosis, 2nd Ed., Daley et al., 2006, Francis J. Curry National Tuberculosis Center Diagnosis of Diseases of the Chest, Fraser & Pare WB Saunders, 1970 Tuberculosis from Head to Toe, Harisinghani et al., RadioGraphics 2000; 20: 449-470 Introduction to Chest Radiology; SB Gay et al., UVA Health Science Center, Department of Radiology, 2003 www.med-ed.virginia.edu/courses/rad/

References
Atlas Radiologic Anatomy; L.Wicke, 7th English Edition, Icon Learning Systems, 2004 Blueprints Radiology; A. Uzelac and RW Davis, Lippincott Williams & Wilkins, 2006 Introduction to Diagnostic Imaging; G. Stimac, WB Saunders 1992 Getting Started in Clinical Radiology; G. Eastman, Wald and Crossin, Thieme, 2006

Questions ???