Chest Radiography

Interpretation:
Pulmonary TB
Lisa Chen , M.D.
Assistant Clinical Professor
Pulmonary and Critical Care Division
Department of Medicine
San Francisco General Hospital
Michael Gotway, MD
Associate Clinical Professor, Radiology
University of California, San Francisco

Primary
Primary TB:
TB: Lung
Lung Parenchyma
Parenchyma
Distribution:
Distribution: Slight
Slight upper
upper lobe
lobe
predominance
predominance but
but any
any lobe
lobe can
can be
be
involved
involved
Air-space
Air-space consolidation
consolidation
Cavitation
Cavitation is
is uncommon
uncommon (<10%)
(<10%)
Miliary
Miliary pattern
pattern

1 TB: Lobar Consolidation

1 TB: Lobar Consolidation

1 TB: Lobar Consolidation

1 TB: Miliary TB

Primary
Primary TB:
TB: Hila
Hila &
& Mediastium
Mediastium
Adenopathy
Adenopathy is
is common,
common, particularly
particularly
in
in children
children and
and HIV
HIV infected
infected
Predilection
Predilection for
for the
the right
right side
side

1 TB: Adenitis

1 TB: Adenitis

1 TB: Adenitis

Primary
Primary Tuberculosis:
Tuberculosis: Pleura
Pleura
Effusions
Effusions common
common in
in adults
adults
Less
Less common
common in
in children
children
May
May be
be only
only finding
finding in
in primary
primary
disease
disease

1 TB: Pleural Effusion

Post
-primary Tuberculosis
Post-primary
Tuberculosis
Lung
Lung Parenchyma
Parenchyma
Distribution
Distribution
apical/posterior
apical/posterior segments
segments of
of upper
upper lobes
lobes
superior
superior segments
segments of
of lower
lower lobes
lobes
right
right side
side more
more common
common
isolated
isolated anterior
anterior segment
segment involvement
involvement is
is
unusual
unusual (think
(think M.
M. avium
avium complex)
complex)

Post-primary TB

Post
-primary Tuberculosis
Post-primary
Tuberculosis
Lung
Lung Parenchyma
Parenchyma
Patterns
Patterns of
of disease
disease
air
air space
space consolidation
consolidation
cavitation
cavitation,, cavitary
cavitary nodule
nodule
endobronchial
endobronchial spread
spread
miliary
miliary
bronchostenosis
bronchostenosis
tuberculoma
tuberculoma

Post-primary
TB: Consolidation

Post 1 TB: RX

Post-primary
TB: Cavitation

Post-primary TB: Cavitary Nodule

Post 1 TB: RX

Post 1 TB:
Endobronchial
Spread of
Infection

Post-primary TB: Miliary

Post-primary TB: Bronchostenosis

Post-primary TB: Bronchostenosis

Post-primary TB: Tuberculoma

Post-primary TB:
Tuberculoma

Post
-primary TB:
Post-primary
TB: Pleura
Pleura
Pleural
Pleural effusions
effusions may
may occur
occur in
in
post-primary
post-primary disease
disease
Empyema
Empyema is
is more
more likely
likely in
in post
post -primary
primary disease
disease
Air
Air // fluid
fluid level
level is
is evidence
evidence of
of aa
bronchopleural
bronchopleural fistula
fistula

Post-primary TB

Post-primary
TB:
Broncho-pleural
fistula

Chest
Chest Radiograph:
Radiograph: TB
TB and
and HIV
HIV
Chest
Chest radiograph
radiograph often
often shows
shows
primary
primary disease
disease pattern
pattern
Adenopathy
Adenopathy is
is common
common and
and highly
highly
predictive
predictive of
of tuberculosis
tuberculosis
Radiograph
Radiograph may
may be
be normal
normal in
in up
up to
to
10%
10% of
of cases
cases

HIV & TB: Adenitis

HIV & TB:

Adenitis

The
The Chest
Chest Radiograph:
Radiograph:
Healed
Healed Tuberculosis
Tuberculosis
Apical
Apical pleural
pleural thickening
thickening
Calcified
Calcified granulomaGhon
granulomaGhon lesion
lesion
Calcified
Calcified granuloma
granuloma and
and hilar
hilar node
node
calcificationRanke
calcificationRanke complex
complex
Fibrosis
Fibrosis and
and volume
volume loss
loss

Healed TB:
Ghon
Lesion

Healed TB:
Ranke
Complex

Healed TB: Apical Pleural Thickening

Healed
TB:
Apical
Pleural
Thickening