Has the following disclosures to make: December 09, 2019 - Heartland National TB Center
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
8/17/2020
TB and Chest Radiology
Megan Devine, MD
December 09, 2019
Navigating Toward TB Free Pacific Islands
December 9‐10, 2019
Majuro, Marshall Islands
1
Megan Devine, MD
has the following disclosures to make:
• No conflict of interests
• No relevant financial relationships with any
commercial companies pertaining to this
educational activity
2
1
8/17/2020
TB and Chest Radiology
Megan Devine, MD
Heartland National TB Center
Assistant Professor of Medicine
UT Health Science Center Tyler
EXCELLENCE EXPERTISE INNOVATION
3
Megan Devine has the following disclosures to
make:
• No conflict of interests
• No relevant financial relationships with any commercial companies
4
2
8/17/2020
Outline
• Normal CXR
• Images of Primary TB
• Images of Post‐primary (Reactivation) TB
• Images of pulmonary complications
• Local images
• Missed diagnosis
5
6
3
8/17/2020
7
Normal CXR Child
8
4
8/17/2020
Cellestis
9
Primary Tuberculosis
• Most commonly in children and immune compromised
patients
• Opacities are seen the in middle and lower lungs
• Commonly unilateral, bilateral 15%
• Lymph node enlargement often occurs, and may cause
bronchial compression
• Hilar or paratracheal lymphadenopathy with or without
infiltrates is characteristic.
10
5
8/17/2020
11
12
6
8/17/2020
Courtesy: Dr. Santiago Restrepo
13
14
7
8/17/2020
Millet Seeds
Slender plant, 1‐15 feet
Seeds ~ 2 mm in diameter
1/3 of grain for 3rd world
Africa and India
Producer: India
15
Miliary Tuberculosis
16
8
8/17/2020
17
Post Primary, Reactivation Tuberculosis
• Characterized by upper lobe predilection, cavitation
and absence of lymphadenopathy.
• Cavitation is the hallmark; can also see parenchymal
disease (consolidation), hematogenous dissemination
(miliary), bronchogenic spread (tree‐in‐bud) and
pleural disease.
• Fibrosis and calcification are seen after healing.
18
9
8/17/2020
19
20
108/17/2020
21
22
118/17/2020
23
Reactivation TB Cavitary Consolidation
Courtesy: Dr. Santiago Restrepo
24
128/17/2020
Tree in Bud……
http://www.jellosalad.com/pic/favorites/index.html
25
26
138/17/2020
27
Pleural Effusions
• Primary TB (25%)
• Hypersensitivity reaction to TB proteins
• Organisms uncommonly isolated from fluid
• May not be associated with obvious parenchymal
disease on CXR
28
28
148/17/2020
29
30
158/17/2020
Pleural Effusions
• Post primary TB (20%)
• Caused by rupture of a tuberculous cavity into the
pleural space, causing empyema
• May cause bronchopleural fistula with air fluid levels
• Often results in irreversible pleural thickening and
calcification
31
31
32
168/17/2020
xxxxxx
33
Tracheobronchial TB
• TB is the most common cause of inflammatory
stricture of a bronchus
• 10% ‐ 20% of TB patients
• Circumferential wall thickening
• Luminal narrowing
• Long segment involvement
• Left > Right
Moon WK, et al. AJR 1997;169:649
34
178/17/2020
Courtesy: Dr. Santiago Restrepo
35
Complications of Pulmonary Tuberculosis
• Bronchiectasis
• Broncholithiasis
• Extensive pulmonary destruction
• Non‐tuberculous mycobacterial disease
• Chronic pulmonary aspergillosis
• Venous thromboembolism
36
188/17/2020
37
38
198/17/2020
39
Local Cases
40
208/17/2020
50yo woman
TST: 29mm
coughx3/day
Exposure (sister &
aunt)
No DM
MTB not detected
CXR: Aug 15, 2018
Copyrights apply
41
Copyrights apply
42
218/17/2020
Copyrights apply
43
28yo woman
TST: 16mm
No Sx/Sym
No Hx TB
No DM
MTB not detected
CXR: July 9, 2018
Copyrights apply
44
228/17/2020
Copyrights apply
45
Copyrights apply
46
238/17/2020
28yo man
TST: 0 MM
No Sx/Sym
No DM
MTB not detected
CXR: August 8, 2018
Copyrights apply
47
Copyrights apply
48
248/17/2020
Copyrights apply
49
Missed Diagnoses
50
258/17/2020
CXR in the ER
51
Missed Diagnoses
52
268/17/2020
Thank you
53
27You can also read
