1. JK Amorosa
Flip - Flop TB R1

2. Tuberculosis Primary –selflimiting
Infection in patients previously not exposed to M tuberculosis (under age 5 in the past, now common in adults also)
Postprimary-progressive
Reactivation and reinfection

3. Chest X-ray is normal in TB in
50%
75%
15%

4. Manifestations of Primary TB are:
Parenchymal disease
Lymphadenopathy
Miliary disease
Pleural Effusion

5. Manifestations of Postprimary TB are:
Upper lobe distribution
Cavity
Absence of adenopathy
Airway involvement

6. Human disease causing mycobacteria are more likely:
Slow growing
Fast growing

7. Mycobacteria – aerobic rods
Categories by disease cause: 1.tuberculosis complex: causes human disease 2.nontuberculous or atypical
Categories by rate of growth: 1.rapid growing: < 7 days 2.slow growing:> 7 days
Rapid: M.abscessus, M.fortiutum, M.chelonae
Slow: MTB, MAC, M.Kansasii

8. Transmission Respiratory
Desiccated bacilli remain airborne for long time – indoor close many months contact is necessary for transmission
Laryngeal, transbronchial, cavitary disease produce most bacilli
Ventillation reduces infectiousness

9. Lung Parenchymal involvement Primary

10. 57 yo f with chronic cough

11. Value of thin section

12. Tuberculous mediastinal adenopathy

13. TB mediastinal adenopathy
19 f

14. TB mediastinal adenopathy is seen as part of
Reactivation TB
HIV
Primary TB usually in children

15. TB mediastinal adenopathy is seen as part of
Reactivation TB
HIV
Primary TB usually in children

16. TB Lymphadenopathy Central low attenuation Active disease Necrosis
R hilar is most common

17. Pathogenesis
TB bacilli in the body elicit acute inflammatory response – no symptoms
Macrophages ingest bacilli and transport them to regional lymph nodes
If not contained in local LNs, hematogenous dissemination of bacilli occurs and usually is contained, if not, then: miliary, meningeal, GU, MSK

18. Miliary

19. 60 f smoker Langerhans Histiocytosis

20. Miliary
Granulomatous, Inflammatory Disorders Bronchiocentric granulomatosis/lung Granulomatous lung disease Sarcoidosis Sarcoidosis, pulmonary Neoplastic Disorders Lymphomas Metastatic lung lymphatics/carcinoma Alveolar cell carcinoma, lung Carcinoma, thyroid, anaplastic
Chickenpox pneumonia Tuberculosis, disseminated Blastomycosis, disseminated Coccidioidomycosis, disseminated Cryptococcosis Histoplasmosis, disseminated Melioidosis Blastomycosis Coccidioidomycosis, pulmonary, chronic Cryptococcosis, pulmonary Filariasis Fungal lung infection Histoplasmosis Histoplasmosis, pulmonary Parasitic lung infection Pulmonary larval infestation/nematodes Pulmonary larval migrans Schistosomiasis

21. Miliary cont
Anatomic, Foreign Body, Structural Disorders Atelectasis, pulmonary Reference to Organ System Respiratory distress (newborn) syndrome Pulmonary fibrosis Pulmonary microlithiasis, alveolar Poisoning (Specific Agent) Silicosis Organ Poisoning (Intoxication) Pneumoconiosis
Allergic, Collagen, Auto- Immune Disorders Pulmonary arteritis/vasculitis Rheumatoid lung disease Metabolic, Storage Disorders Histiocytosis, pulmonary Histiocytosis X Hereditary, Familial, Genetic Disorders Tuberous Sclerosis

22. Pleural Effusion TB

23. TB pleurisy Unilateral
Exudative: high protein content, High WBC, low glucose
Lymphocyte predominance
Complications: B-P fistula, empyema
1/3 negative TB skin test

24. Pleural Effusion exudative
Malignancy
Pneumonia
Tuberculosis
Pulmonary embolism
Fungal infection
Pancreatic pseudocyst
Intra-abdominal abscess
After coronary artery bypass graft surgery
Postcardiac injury syndrome
Pericardial disease
Meigs syndrome
Ovarian hyperstimulation syndrome
Rheumatoid pleuritis
Lupus erythematosus
Drug-induced pleural disease
Asbestos pleural effusion
Yellow nail syndrome
Uremia
Trapped lung
Chylothorax
Pseudochylothorax
Acute respiratory distress syndrome
Chronic pleural thickening
Malignant mesothelioma

25. Pleural Effusion transudate: <3 g protein, low WBC, normal glucose
Congestive heart failure (most common)
Cirrhosis with hepatic hydrothorax
Nephrotic syndrome
Peritoneal dialysis/continuous ambulatory peritoneal dialysis
Hypoproteinemia
Glomerulonephritis
Superior vena cava obstruction
Fontan procedure
Urinothorax
CSF leak to the pleural space

26. 83 f

27. TB bacilli spread to meninges via:
Inhalation to lymphnodes to bloodstrean to meninges
Inhalation to lymphnodes to meninges
Ingestion to peritoneum to CSF
Intravenous introduction to meninges

28. TB bacilli spread to meninges via:
Inhalation to lymphnodes to bloodstream to meninges
Inhalation to lymphnodes to meninges
Ingestion to peritoneum to CSF
Intravenous introduction to meninges

29. Manifestations of Postprimary TB are:
Upper lobe distribution
Cavity
Absence of adenopathy
Airway involvement

30. 53 m

31. 37 m

33. 40 m with cough

37. Cavity vs cyst vs bulla
Cavity: Gas-filled space in an area of lung consolidation or mass or nodule produced by the expulsion of a necrotic part of the lesion via the bronchial tree; wall thickness varies
Cyst: wall thickness is 4 mm or less
Bulla: wall thickness < 4 mm
Often difficult to distinguish the 3
Clin Microbiol Rev April; 21(2): 305–333

38. Cavity - causes Abscess TB Ischemic necrosis (infarct) PCP
Fungal process
Malignancy
Wegener’s granulomatosis
Sarcoidosis – rare
COP (Cryptogenic Organizing Pneumonia -rare

41. Cavity
T bacilli grow in cavities which communicate with bronchi and spread infection
MDR bacilli grow in cavities exclusively
Hydrolytic enzymes break down lung
Tuberculosis Volume 89, Issue 4 , Pages , July 2009

43. 54 m

44. 48 m

46. Cryptococcus

47. 35 f

49. Aspergillus AML

50. 57 f

51. Primary lung ca with mets

52. 67 f

53. 43 m

55. 34 m

56. 43 m

58. Bronchopneumonia

59.  Invasive bronchiolar aspergillosis in a patient who underwent bone marrow transplantation
RadioGraphics,
Aspergillus

60. Five causes of tree-in-bud are:
Bronchopneumonia
Fungal
Viral
ABPA TB

61. Tree –in-bud pattern
Rossi, SE et al: May/June 2005 Radiographics 25,3

62. Cocaine 23 m

63. 25 m

64. TB in HIV

65. TB & HIV Clinical features depend on the severity immunosuppression
Relatively intact cellular immunity = non– HIV-infected individuals- TB remains localized to the lung.
HIV (CD4 T-lymphocyte count: <200/mm3), pulmonary TB with extra-pulmonary involvement: lymphadenitis, miliary

67. 46 m

69. 76 m emphysematous pericarditis, streptococcal

70. TB - healing
Lung destruction: bronchiectasis
Bronchial stenosis

71. LUL atelectasis, bronchiectasis TB

72. 77 m

74. Radical mastectomy & rad Rx

75. 80 f

76. The History of Tuberculosis
The Hebrew word for phthisis or consumption (schachepheth) means to waste away occurs twice in the Bible:
Leviticus 26:16
I, in turn, will do this to you: I will appoint over you a sudden terror, consumption and fever that will waste away the eyes and cause the soul to pine away; also you will sow your seed uselessly, for your enemies will eat it up.
Deuteronomy 28:22
The Lord will smite you with consumption and with fever and with inflammation and with fiery heat and with the sword and with blight and with mildew and they will pursue you until you perish.

77. The History of Tuberculosis
By 1650 consumption was the leading cause of mortality and became a reference in some of Shakespeare's plays- one of the consumptive lovers, in "Much A Do About Nothing" , as well as scrofula in "Macbeth"

78. The History of Tuberculosis
Early attempts at treatment can be found throughout history
Greeks believed cutting off cool air eventuated in a burning up of the tissues
Romans put importance of diet
Hebrews control disease from diet to the destruction of clothing
Early "cures" from physicians
Warm sea air
Milk from pregnant women
Seaweed placed under the pillow
Cold baths
Deep breathing

79. The History of Tuberculosis
The first breakthrough came when German bacteriologist named Robert Koch isolated the infectious agent known as tuberculosis bacteria or tubercle bacilli in He was later awarded the Nobel Prize for physiology or medicine in 1905

80. The History of Tuberculosis
The first sanatorium opened in 1854 in Gorbersdorf, Germany. Sick patients were given wholesome food and plenty of fresh air. This became the modern way to fight the disease. The sanatoriums provided medical care for almost 100 years and became one of the most remarkable and unique periods of medical care in history.
By 1889 in the USA the National Tuberculosis Association fully realized that TB was distinctly preventable and not directly inherited
No real progress was made until new antibiotics were used between
It has taken almost three thousand years to understand the full nature of Tuberculosis

81. 58 m

82. References
Joshua Burrill, Christopher J. Williams, Gillian Bain, Gabriel Conder, Andrew L. Hine, Rakesh R. Misra RadioGraphics, 2007, Vol.27: , /rg
Santiago Enrique Rossi, Tomas Franquet, Mariano Volpacchio, Ana Giménez, Gabriel Aguilar RadioGraphics, 2005, Vol.25:
JR Cohen, JK Amorosa, PR Smith –The air-fluid level in cavitary pulmonary TB, Radiology, radiology
JK Amorosa, PR Smith, JR Cohen, C Ramsey… - …, Tuberculous mediastinal lymphadenitis in the adult
1978 – radiology
Medscape Tuberculosis (TB), a multisystemic disease ….JK Amorosa….

83. Famous people who had TB
Gaius Valerius Catullus (ca. 84 BC – ca. 54 BC), Roman poet
Bronte sisters
Elizabeth Barrett Browning
Albert Camus
Anton Chekhov
Maxim Gorky
Franz Kafka
Eugene O'Neill
Eugene O'Neill
Molière
Robert Louis Stevenson
Dylan Thomas
Voltaire
Paul Gauguin
Amedeo Modigliani
Frédéric Chopin
Niccolò Paganini
Igor Stravinsky
Cardinal Richelieu
Simón Bolívar

84. Opera, Theatre, Novels - TB
Puccini: La boheme
Verdi: La Traviata
Thomas Mann: The Magic Mountain
Victor Hugo: Les Miserables
Upton Sinclair: The Jungle
Johnny Nolan: A Tree Grows in Brooklyn
W.Somerset Maugham: Sanatorium
Frank McCourt: Angela’s Ashes

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