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Chest
Diagnosis
Infections
Bacteria
Tuberculosis
Tuberculosis
Melissa L. Rosado de Christenson, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Tuberculosis (TB)
              • Mycobacterium tuberculosis (MTB)
              • Mycobacterium tuberculosis complex: M. tuberculosis, M. bovis, M. africanum, M. microti, M. canettii

            • Definitions

              • MTB: Airborne infection; person-to-person transmission via organism-containing droplets (1-5 μm)
                • Aerobic, nonmotile, non-spore-forming acid-fast bacillus
              • Primary TB: Droplets infect alveolar macrophages → active TB within first 1-2 years (5%); contagious
              • Post-primary (reactivation) TB: Infection initially controlled by immune system (5%); viable dormant organisms reactivate at later date
              • Re-infection TB: Different DNA finger-printing between initial and subsequent infections
              • Latent TB: Noncontagious infected individuals that do not develop symptomatic disease (~ 90%)
              • Multidrug-resistant TB (MDR TB): Resistance to at least isoniazid and rifampin
              • Extensively drug-resistant TB (XDR TB): Resistance to isoniazid, rifampin, any fluoroquinolone, and at least 1 of 3 injectable second-line drugs (kanamycin, capreomycin, amikacin)

            IMAGING

            • Radiographic Findings

              • CT Findings

                • Nuclear Medicine Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          • Microscopic Features

                            • Microbiology

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      • Prognosis

                                        • Risk Factors

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            Selected References

                                            1. Global Tuberculosis Report 2020. World Health Organization. 2020
                                            2. Urbanowski ME et al: Cavitary tuberculosis: the gateway of disease transmission. Lancet Infect Dis. 20(6):e117-28, 2020
                                            3. Carlesi E et al: How radiology can help pulmonary tuberculosis diagnosis: analysis of 49 patients. Radiol Med. 124(9):838-45, 2019
                                            4. Furin J et al: Tuberculosis. Lancet. 393(10181):1642-56, 2019
                                            5. Ankrah AO et al: Tuberculosis. Semin Nucl Med. 48(2):108-30, 2018
                                            6. Poeta P et al: Tuberculosis in the 21th century: current status of diagnostic methods. Exp Lung Res. 44(7):352-60, 2018
                                            7. Nachiappan AC et al: Pulmonary tuberculosis: role of radiology in diagnosis and management. Radiographics. 37(1):52-72, 2017
                                            8. Kim W et al: CT and microbiologic follow-up in primary multidrug-resistant pulmonary tuberculosis. Acta Radiol. 57(2):197-204, 2016
                                            9. Interrante JD et al: Exogenous reinfection as a cause of late recurrent tuberculosis in the United States. Ann Am Thorac Soc. 12(11):1619-26, 2015
                                            10. Rozenshtein A et al: Radiographic appearance of pulmonary tuberculosis: dogma disproved. AJR Am J Roentgenol. 204(5):974-8, 2015
                                            11. World Health Organization: Global tuberculosis report. 20th ed. Geneva: WHO Press, 2015
                                            12. Ko JM et al: Pulmonary changes of pleural TB: up-to-date CT imaging. Chest. 146(6):1604-11, 2014
                                            13. Kim HS et al: Serial CT findings of Mycobacterium massiliense pulmonary disease compared with Mycobacterium abscessus disease after treatment with antibiotic therapy. Radiology. 263(1):260-70, 2012
                                            14. Song I et al: Tuberculous lymphadenitis of the thorax: comparisons of imaging findings between patients with and those without HIV infection. AJR Am J Roentgenol. 199(6):1234-40, 2012
                                            15. Tiemersma EW et al: Natural history of tuberculosis: duration and fatality of untreated pulmonary tuberculosis in HIV negative patients: a systematic review. PLoS One. 6(4):e17601, 2011
                                            16. Crampin AC et al: Recurrent TB: relapse or reinfection? The effect of HIV in a general population cohort in Malawi. AIDS. 24(3):417-26, 2010
                                            17. Kim EY et al: Pulmonary mycobacterial disease: diagnostic performance of low-dose digital tomosynthesis as compared with chest radiography. Radiology. 257(1):269-77, 2010
                                            18. Kliiman K et al: Predictors and mortality associated with treatment default in pulmonary tuberculosis. Int J Tuberc Lung Dis. 14(4):454-63, 2010
                                            19. Jeong YJ et al: Pulmonary tuberculosis: up-to-date imaging and management. AJR Am J Roentgenol. 191(3):834-44, 2008
                                            20. Chung MJ et al: Drug-sensitive tuberculosis, multidrug-resistant tuberculosis, and nontuberculous mycobacterial pulmonary disease in nonAIDS adults: comparisons of thin-section CT findings. Eur Radiol. 16(9):1934-41, 2006
                                            21. Heo JN et al: Pulmonary tuberculosis: another disease showing clusters of small nodules. AJR Am J Roentgenol. 184(2):639-42, 2005
                                            22. Andreu J et al: Radiological manifestations of pulmonary tuberculosis. Eur J Radiol. 51(2):139-49, 2004
                                            23. Neralla S et al: Mycobacterium tuberculosis: the treatment of active disease. Semin Respir Infect. 18(4):292-306, 2003
                                            24. Choi YW et al: Tuberculous pleural effusion: new pulmonary lesions during treatment. Radiology. 224(2):493-502, 2002
                                            25. Nakatsu M et al: Large coalescent parenchymal nodules in pulmonary sarcoidosis: "sarcoid galaxy" sign. AJR Am J Roentgenol. 178(6):1389-93, 2002
                                            26. Lee JY et al: Pulmonary tuberculosis: CT and pathologic correlation. J Comput Assist Tomogr. 24(5):691-8, 2000
                                            27. Cohen RA et al: Diagnosis of pulmonary tuberculosis using PCR assays on sputum collected within 24 hours of hospital admission. Am J Respir Crit Care Med. 157(1):156-61, 1998
                                            28. Ellison E et al: Cytologic features of mycobacterial pleuritis: logistic regression and statistical analysis of a blinded, case-controlled study. Diagn Cytopathol. 19(3):173-6, 1998
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Tuberculosis (TB)
                                                        • Mycobacterium tuberculosis (MTB)
                                                        • Mycobacterium tuberculosis complex: M. tuberculosis, M. bovis, M. africanum, M. microti, M. canettii

                                                      • Definitions

                                                        • MTB: Airborne infection; person-to-person transmission via organism-containing droplets (1-5 μm)
                                                          • Aerobic, nonmotile, non-spore-forming acid-fast bacillus
                                                        • Primary TB: Droplets infect alveolar macrophages → active TB within first 1-2 years (5%); contagious
                                                        • Post-primary (reactivation) TB: Infection initially controlled by immune system (5%); viable dormant organisms reactivate at later date
                                                        • Re-infection TB: Different DNA finger-printing between initial and subsequent infections
                                                        • Latent TB: Noncontagious infected individuals that do not develop symptomatic disease (~ 90%)
                                                        • Multidrug-resistant TB (MDR TB): Resistance to at least isoniazid and rifampin
                                                        • Extensively drug-resistant TB (XDR TB): Resistance to isoniazid, rifampin, any fluoroquinolone, and at least 1 of 3 injectable second-line drugs (kanamycin, capreomycin, amikacin)

                                                      IMAGING

                                                      • Radiographic Findings

                                                        • CT Findings

                                                          • Nuclear Medicine Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      • Microbiology

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                • Prognosis

                                                                                  • Risk Factors

                                                                                    DIAGNOSTIC CHECKLIST

                                                                                    • Consider

                                                                                      Selected References

                                                                                      1. Global Tuberculosis Report 2020. World Health Organization. 2020
                                                                                      2. Urbanowski ME et al: Cavitary tuberculosis: the gateway of disease transmission. Lancet Infect Dis. 20(6):e117-28, 2020
                                                                                      3. Carlesi E et al: How radiology can help pulmonary tuberculosis diagnosis: analysis of 49 patients. Radiol Med. 124(9):838-45, 2019
                                                                                      4. Furin J et al: Tuberculosis. Lancet. 393(10181):1642-56, 2019
                                                                                      5. Ankrah AO et al: Tuberculosis. Semin Nucl Med. 48(2):108-30, 2018
                                                                                      6. Poeta P et al: Tuberculosis in the 21th century: current status of diagnostic methods. Exp Lung Res. 44(7):352-60, 2018
                                                                                      7. Nachiappan AC et al: Pulmonary tuberculosis: role of radiology in diagnosis and management. Radiographics. 37(1):52-72, 2017
                                                                                      8. Kim W et al: CT and microbiologic follow-up in primary multidrug-resistant pulmonary tuberculosis. Acta Radiol. 57(2):197-204, 2016
                                                                                      9. Interrante JD et al: Exogenous reinfection as a cause of late recurrent tuberculosis in the United States. Ann Am Thorac Soc. 12(11):1619-26, 2015
                                                                                      10. Rozenshtein A et al: Radiographic appearance of pulmonary tuberculosis: dogma disproved. AJR Am J Roentgenol. 204(5):974-8, 2015
                                                                                      11. World Health Organization: Global tuberculosis report. 20th ed. Geneva: WHO Press, 2015
                                                                                      12. Ko JM et al: Pulmonary changes of pleural TB: up-to-date CT imaging. Chest. 146(6):1604-11, 2014
                                                                                      13. Kim HS et al: Serial CT findings of Mycobacterium massiliense pulmonary disease compared with Mycobacterium abscessus disease after treatment with antibiotic therapy. Radiology. 263(1):260-70, 2012
                                                                                      14. Song I et al: Tuberculous lymphadenitis of the thorax: comparisons of imaging findings between patients with and those without HIV infection. AJR Am J Roentgenol. 199(6):1234-40, 2012
                                                                                      15. Tiemersma EW et al: Natural history of tuberculosis: duration and fatality of untreated pulmonary tuberculosis in HIV negative patients: a systematic review. PLoS One. 6(4):e17601, 2011
                                                                                      16. Crampin AC et al: Recurrent TB: relapse or reinfection? The effect of HIV in a general population cohort in Malawi. AIDS. 24(3):417-26, 2010
                                                                                      17. Kim EY et al: Pulmonary mycobacterial disease: diagnostic performance of low-dose digital tomosynthesis as compared with chest radiography. Radiology. 257(1):269-77, 2010
                                                                                      18. Kliiman K et al: Predictors and mortality associated with treatment default in pulmonary tuberculosis. Int J Tuberc Lung Dis. 14(4):454-63, 2010
                                                                                      19. Jeong YJ et al: Pulmonary tuberculosis: up-to-date imaging and management. AJR Am J Roentgenol. 191(3):834-44, 2008
                                                                                      20. Chung MJ et al: Drug-sensitive tuberculosis, multidrug-resistant tuberculosis, and nontuberculous mycobacterial pulmonary disease in nonAIDS adults: comparisons of thin-section CT findings. Eur Radiol. 16(9):1934-41, 2006
                                                                                      21. Heo JN et al: Pulmonary tuberculosis: another disease showing clusters of small nodules. AJR Am J Roentgenol. 184(2):639-42, 2005
                                                                                      22. Andreu J et al: Radiological manifestations of pulmonary tuberculosis. Eur J Radiol. 51(2):139-49, 2004
                                                                                      23. Neralla S et al: Mycobacterium tuberculosis: the treatment of active disease. Semin Respir Infect. 18(4):292-306, 2003
                                                                                      24. Choi YW et al: Tuberculous pleural effusion: new pulmonary lesions during treatment. Radiology. 224(2):493-502, 2002
                                                                                      25. Nakatsu M et al: Large coalescent parenchymal nodules in pulmonary sarcoidosis: "sarcoid galaxy" sign. AJR Am J Roentgenol. 178(6):1389-93, 2002
                                                                                      26. Lee JY et al: Pulmonary tuberculosis: CT and pathologic correlation. J Comput Assist Tomogr. 24(5):691-8, 2000
                                                                                      27. Cohen RA et al: Diagnosis of pulmonary tuberculosis using PCR assays on sputum collected within 24 hours of hospital admission. Am J Respir Crit Care Med. 157(1):156-61, 1998
                                                                                      28. Ellison E et al: Cytologic features of mycobacterial pleuritis: logistic regression and statistical analysis of a blinded, case-controlled study. Diagn Cytopathol. 19(3):173-6, 1998