1. PULMONARY TUBERCULOSIS - RADIOLOGICAL IMAGES -
Dr. Miron Ramona
Conf Dr Antigona Trofor

2. TUBERCULOSIS RADIOLOGY
Pulmonary tuberculosis, especially postprimary disease, nearly always causes abnormalities on chest radiographs.
Typically, the disease is parenchymal without nodal enlargement, and it manifests as cavitary lesions.
Upper-lobe involvement with cavitation and the absence of lymphadenopathy are helpful in distinguishing postprimary TB from primary TB.
In addition to the usually involved pulmonary segments—namely, the apical or posterior segments of the upper lobe or the superior segment of a lower lobe—anterior or basal segments may be involved in as many as 75% of cases.

3. PRIMARY TUBERCULOSIS RADIOLOGY
Radiographic screening for active TB in high-risk populations may demonstrate findings consistent with prior and/or current infection.
A Ghon focus refers to the initial site of parenchymal involvement at the time of first infection;
A Ranke complex is the combination of a Ghon focus and enlarged or calcified lymph nodes;
Lymphadenopathy is the radiologic hallmark of primary TB
Simon focus are apical nodules that are often calcified and result from hematogenous seeding at the time of initial infection

4. PRIMARY PULMONARY TB Initial pulmonary lesions GOHN-RANKE complex
Focus Gohn
Lymphangitis Ranke Complex
Lymphadenopathy
Image in “halter”

5. Afect Adenita Limfangita
Complexul Ranke

6. Complexul primar Ranke:
GOHN focus (alveolitis)=basal subpleural nodular opacities (most often on right), flou contour
Lymphangitis: radiological expression, in some case appear fibrosis; fine linear opacities that connect the Gohn focus with hilum
Homolateral adenopathy: hilary, interbronchial or paratracheal rounded shape, massive polyciclic aspect, 3 2 1

7. Complex forms
Excavation of caseous alveolitis focus– primary cavern (cavity) transparent thin wall or anfractuous circumscribed, usually localized on the basal or middle lung fields, is accompanied by hilary adenopathy.
Voluminous adenophaties: cause ventilation modifications by extrabronchial compression, obstructive emphysema or systematized atelectasis

8. Vouluminous right hilar adenopathy
Segmental atelectasis in upper right lobe

9. Complicated forms Large cavitary tuberculosis with forms:
Pneumonia: triangular opacity
- Can do to excavation
Is accompanied by adenopathy
Pneumonie TB lob superior drept

10. Associated adenopathies!
Bronchopneumonia:
Macronodulare alveolar opacities, various sizes, unequal distribution, with a tendency to confluence
Associated adenopathies!
Right paratracheal adenopathy
Miliary nodules

12. Miliary tuberculosis Complication of Primary TB
Radiological: miliary opacities with diameter < 3 mm, equal in size, homogeneous distribution

13. Secondary tuberculosis
Occurs due to reactivation of primary tuberculosis
Reactivation of fibrotic lesions from apical territory
Reinfection by exogenous contamination
Can occur after primary infection,
Radiology- polymorphic semiology!
Alveolar opacities systematized/nonsystematized;
Nodular images, cavitary lesions, fibrous lesions, associated lesions
The affected territories predilection: dorsal and apical segments of upper lobes and apical segments of lower lobes!

14. INFILTRATIVE TUBERCULOSIS
PLEURAL TB
CAVITARY CHRONIC TUBERCULOSIS
MYLIAR TUBERCULOSIS
FIBROTIC TUBERCULOSIS
TUBERCULOMA

15. 1. INFILTRATIVE TUBERCULOSIS
Lesions of exudative alveolitis
Early infiltrates localize subclavicular
RADIOLOGY:
NODULAR INFILTRATE
ROUND INFILTRATE(ASSMAN)
NEBULOUS INFILTRATE
SEGMENTAL INFILTRATE
Beginning of secondary TB can be: pneumonia, lobar or segmental opacities , bronchopneumoni

16. Nodular infiltrate LUL
infiltrative TB RUL

17. Bilateral INFILTRATIVE LESIONS

18. Disseminated nodular opacities in both lung fields, most commonly in middle and basal lung fields, moderate intensity, different size, shape removed, the tendency to confluence TB
Bronchopneumonia

19. Triangular opacity localized RUL
TB Pneumonia

20. Massive left pneumonia – etiology TB
Segmental infiltrate occupying almost the entire RUL and central tendency to excavation
Massive left pneumonia – etiology TB

21. Opacity nonhomogeneous RUL
Pneumonia LUL

22. TB PLEURAL EFFUSION
In a patient with pleural exudate, TB is the first etiology to be taken into consideration!

23. Radiological aspect of cavities(caverns) depends on the stage in which there are:
Cavity grade 1
Cavity grade 2
Cavity grade 3
Cavity grade 1:
Lucency (darkened area) within the lung parenchyma, with or without irregular margins

24. CAVITY GRADE 2 :wall has its own thin, elastic, net contour
Cavern with net wall localized RUL subclavicular

25. Cavity grade 2
Between cavern and hilum- drainage bronchia

26. Cavity grade 2

27. Cavity grade 3: old cavity, net shaped, wall fibrosis, cavitary sclerosis may be due to irregular shape, around the cavity disabling injuries. Calcification can exist around a cavity.

28. Old cavity, net contour, fibrosis of wall, sclerosis around cavity
Cavity grade 3
Old cavity, net contour, fibrosis of wall, sclerosis around cavity

29. Radiological aspects of cavitary TB
Multiple cavities in different stages of evolution

30. Radiological aspects of cavitary TB

31. Radiological aspects of cavitary TB

32. Radiological aspects of cavitary TB
small, multiple aspects in different stages of evolution

33. Complications of cavitary
SEROFIBRINOUS PLEURESY
PACHIPLEURITIS(PLEURAL ADHESIONS)
(AFTER RESORBTION OF EXUDATE)
PLEURAL EMPYEMA
(INFECTION OF EXUDATE)
PARTIAL/TOTAL SPONTANEOUS PNEUMOTHORAX
BRONCHOGENIC DISEMINATIONS

34. Complications of cavitary TB
TB infiltrative lesions of RUL
Mixed image horizontal line of the air-fluid level right hemithorax
PLEURAL EMPYEMA

35. Complications of cavitary TB
TB left empyema
Infiltrative lesions of right lung

36. Complications of cavitary TB
Pulmonary hiperlucency design collapsed lung to hilum (right lung field), large infiltrative lesions (left lung field)

37. Bilateral infiltrative lesions RIGHT Pneumothorax
Complications of cavitary TB
Bilateral infiltrative lesions
RIGHT Pneumothorax

38. Bilateral infiltrative lesions
Complications of cavitary TB
Bilateral infiltrative lesions
Right hydro-pneumothorax

39. ” Complications of cavitary TB – bronchogenic dissemination
Micronodular opacities, diffuse shape, vaguely defined, tendency to confluence to delimit small areas excavated

40. Complications of cavitary TB – bronchogenic dissemination
Bronchogenic dissemination from RUL to LIL (disemination type “Cardis”)

41. Complications of cavitary TB – bronchogenic dissemination
Hiperlucency excluding left lung, with attraction of trachea to the left, ascension compensatory of the diaphragm, hyperinflation of contralateral lung, right lung shows extensive infiltrative lesions and a cavity to the apex
Images - multi-drug resistance TB

42. Miliary TB - miliary nodules distributed homogenous in both lung fields

43. POSTUBERCULOSIS FIBROSIS
Retraction of LUL with fibrous lesions extended to right lung
Basal left pachipleuritis

44. FIBROTHORAX -The final process of sclerosis that interested entirely the lung
Sclerosis of right lung
Retraction of left hemithorax
Nodular lesions of left lung

45. 5. Tuberculoma
Radiological: round, oval, encapsulated opacity, homogeneous or heterogeneous structure, net shape, can be solitary or multiple lesions
Seriate radiographs show stability in time!