Tuberculosis natural history, complications and prognosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Tuberculosis}}
{{Tuberculosis}}
{{CMG}}; {{AE}} {{JS}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{JS}}


==Overview==
==Overview==
[[Tuberculosis]] [[complications]] are [[Lung|pulmonary]] and extra-pulmonary. Moreover, they include severe [[parenchymal]], [[vascular]], [[pleural]] and [[Thoracic cavity|chest wall]] complications.  The pulmonary [[complications]] of [[tuberculosis]] include [[pneumonia]], [[pleural effusion]]s, [[bronchiectasis]], [[cavitations]], and [[lymphadenopathy]]. The [[hematogenous]] [[Metastasis|spread]] of infection resuts in [[miliary tuberculosis]]. Without effective medical [[therapy]], 1/3 of patients with active [[tuberculosis]] die within 1 year of [[diagnosis]], and more than 50% die during the first 5 years.  However, ''M. [[tuberculosis]]'' [[Infection|infections]] carry a good [[prognosis]] if diagnosed early and treated effectively.


==Natural History==
==Natural History==
Without treatment, 1/3 of patients with active tuberculosis dies within 1 year of the diagnosis, and more than 50% during the first 5 years. Patients who have a positive sputum smear test for [[M. tuberculosis]] have a 5-year [[mortality rate]] of 65%.  Those who survive past these 5 years, have 60% of probability of undergoing spontaneous remission.  <ref name="Harrisons">{{cite book | last = Longo | first = Dan | title = Harrison's principles of internal medicine | publisher = McGraw-Hill | location = New York | year = 2012 | isbn = 007174889X }}</ref>
Without proper medical [[therapy]], 1/3 of patients with active [[tuberculosis]] die within 1 year of the diagnosis, and more than 50% during the first 5 years. The 5-year [[mortality rate]] in patients with a positive sputum smear test for ''[[M. tuberculosis]]'' is 65%.  Patients who survive the 5 years have [[probability]] of 60% of spontaneous [[Remission (medicine)|remission]].  <ref name="Harrisons">{{cite book | last = Longo | first = Dan | title = Harrison's principles of internal medicine | publisher = McGraw-Hill | location = New York | year = 2012 | isbn = 007174889X }}</ref>


According to its clinical manifestations, pulmonary tuberculosis may be classified as primary or secondary (or post-primary) tuberculosis:<ref name="Harrisons"></ref>
===Primary Pulmonary Tuberculosis===
===Primary Pulmonary Tuberculosis===
Primary tuberculosis develops soon after infection with ''[[M. tuberculosis]]'' and differs from clinical illness. In [[endemic]] regions, this form of TB is frequently seen at younger ages. Primary TB may be [[asymptomatic]], or include mild [[symptoms]], such as [[cough]], [[fever]] and [[chest pain]], related to [[pleurisy]]. Some patients may develop concomitant symptoms, such as [[erythema nodosum]] in the lower limbs and [[phlyctenulosis]].  The initial lesion ([[Ghon focus]]) often resolves spontaneously, becoming a calcified nodule that may be identified on the [[chest X-Ray]].  [[Pleuritic chest pain]] often results from the [[pleural]] reaction to the underlying [[Ghon focus]].<ref name="Harrisons"></ref>
Primary tuberculosis occurs soon after infection with ''[[M. tuberculosis]]'' and differs from clinical illness. In [[endemic]] areas, primary TB is usually observed at a young age. Primary TB may be completely [[asymptomatic]], or iinvolves mild [[symptoms]], such as [[fever]], [[cough]], and [[chest pain]], due to [[pleurisy]]. Some patients can have other symptoms, such as [[erythema nodosum]] in the lower limbs and [[phlyctenulosis]].  The initial lesion ([[Ghon focus]]) often resolves spontaneously, becoming a calcified nodule that may be identified on the [[chest X-Ray]].  [[Pleuritic chest pain]] usually occurs as a result of the [[pleural]] reaction to the underlying [[Ghon focus]].<ref name="Harrisons"></ref>


Primary tuberculosis progresses more rapidly in patients with impaired [[immune system]] and in children, who commonly have immature [[cellular immunity]].  Progression of the disease leads to the enlargement of the [[Ghon focus]].  The disease may be manifested with:<ref name="Harrisons"></ref>
The progression of primary TB is more rapidly in patients with impaired [[immune system|immunity]] and in children.  Progression of primary [[tuberculosis]] results in the enlargement of the [[Ghon focus]].  The disease may have the following manifestations:<ref name="Harrisons"></ref>
*[[Pleural effusion]] - results from invasion of the [[pleural space]] by ''[[M. tuberculosis]]''.  This occurs more frequently when the focus of [[infection]] is subpleural.
*[[Cavitation]] - results from rapid enlargement of the [[Ghon focus]], with ensuing [[necrosis]] of its nucleus.
*[[Lymphadenopathy]] - the spread of ''[[M. tuberculosis]]'' from the [[lungs]] to [[lymph]] leads to the enlargement of [[lymph nodes]], especially of the paratracheal and [[hilar|perihilar]] regions.
*[[Airway obstruction]] - with [[symptoms]] of [[shortness of breath]] and [[wheezing]]. Commonly occurs in cases of severe enlargement of the [[lymph nodes]], that compress the [[airways]] and possibly lead to distal collapse, partial obstruction with [[wheezing]], or hyperinflation.
*[[Pneumonia]] - may occur when there is rupture and leakage of [[lymph node]] content into the [[airways]].
*[[Bronchiectasis]] - progressive [[pneumonia]] may damage a specific segment of the [[lung]], or an entire [[lung|lobe]], leading to [[bronchiectasis]].


Primary [[infection]] leads to dissemination of ''[[M. tuberculosis]]'' through the [[blood]]. [[blood|Hematogenous]] dissemination is often contained by an healthy [[immune system]], however, in cases of compromised [[immune]] response, [[miliary tuberculosis]] may occur.  Dissemination of the [[M. tuberculosis|mycobacteria]] may lead to the formation of [[granulomatous]] lesions in other organs, which may develop different forms of the disease.<ref name="Harrisons"></ref>
*[[Pleural effusion]] - results from invasion of the [[pleural space]] by ''[[M. tuberculosis]]''.  Usually occurs with [[subpleural]] focus of infection.
*[[Cavitation]] - results from progressive enlargement of the [[Ghon focus]] and [[necrosis]] of its center.
*[[Lymphadenopathy]] - the [[dissemination]] of ''[[M. tuberculosis]]'' from the [[lungs]] to [[lymph]] leads to the enlargement of [[lymph nodes]]  particularly the [[Paratracheal lymph nodes|paratracheal]] and [[hilar|perihilar]] [[Lymph nodes|lymph node]]<nowiki/>s.
*[[Airway obstruction]] - presents with [[shortness of breath]] and [[wheezing]]. Usually occurs as a result of severe enlargement of the [[lymph nodes]], compressing the [[airways]] resulting in distal [[Collapse (medical)|collapse]], partial [[obstruction]], or [[hyperinflation]].
*[[Pneumonia]] - results from rupture and leakage of [[lymph node]] content into the [[airways]].
*[[Bronchiectasis]] - results from progressive [[pneumonia]] that damages a specific segment of the [[lung]], or an entire [[lung|lobe]], leading to [[bronchiectasis]].


[[image:Miliary TB.jpg|400|thumb|center|Chest X-Ray of patient with Miliary Tuberculosis<SMALL><SMALL>''[http://commons.wikimedia.org/wiki/Main_Page Image from Wikimedia Commons]''<ref name="Wikimedia Commons">{{Cite web | title = Wikimedia Commons | url =  http://commons.wikimedia.org/wiki/Main_Page}}</ref></SMALL></SMALL>]]
Primary [[infection]] leads to dissemination of ''[[M. tuberculosis]]'' through the [[blood]].  With impaired [[immune]] response, [[miliary tuberculosis]] may occur resulting in the formation of [[granulomatous]] lesions in several organs.<ref name="Harrisons"></ref>
 
[[image:Miliary TB.jpg|600px|thumb|center|Chest X-Ray of patient with Miliary Tuberculosis<SMALL><SMALL>''[http://commons.wikimedia.org/wiki/Main_Page Image from Wikimedia Commons]''<ref name="Wikimedia Commons">{{Cite web | title = Wikimedia Commons | url =  http://commons.wikimedia.org/wiki/Main_Page}}</ref></SMALL></SMALL>]]


===Secondary Pulmonary Tuberculosis===
===Secondary Pulmonary Tuberculosis===
Also known as "adult-type" or "post primary tuberculosis".  May result from recent [[infection]] with ''[[M. tuberculosis]]'', or from the reactivation of an [[endogenous]] focus that contained the latent form of the disease.  Without treatment, about 1/3 of patients dies within months of disease onset.  Of the remaining 2/3, some may experience remission, while others develop a chronic condition with debilitating [[symptoms]].  The surviving patients may show fibrotic and calcified lesions, as well as cavitations in some areas of the [[lungs]], which may be later appreciated on a [[chest X-Ray]].<ref name="Harrisons"></ref>
Also known as "adult-type" or "post-primary tuberculosis".  May result from recent [[infection]] with ''[[M. tuberculosis]]'', or from the reactivation of an [[endogenous]] focus containing the latent form of the infection.  Without effective medical therapy, approximately 1/3 of patients die within months of disease onset.  Of the remaining 2/3, some can develop spontaneous remission, while others experience a chronic infection with severe [[symptoms]].  The survivors may have fibrotic and calcified lesions, and cavitations in some areas of the [[lungs]], that can be detected later on a [[chest X-Ray]].<ref name="Harrisons"></ref>
 
The onset of illness is insidious and nonspecific, and the [[symptoms]] include:
 
*[[Fever]]
*[[Night sweats]]
*[[Weakness]]
*[[Malaise]]
*[[Anorexia]]
*[[Weight loss]]
*[[Cough]] (90% cases) - nonproductive at the outset, more frequent during the morning, that gradually progresses to [[productive cough]], with [[purulent]] sputum, with occasional streaks of blood
*[[Hemoptysis]] (20-30% cases) may occur in the following cases:


Disease onset is insidious and unspecific, presenting with [[symptoms]] that may include:
:*Rupture of a [[blood vessel]] on a cavity wall leads to severe [[hemoptysis]]
* [[Fever]]
* [[Night sweats]]
* [[Weakness]]
* [[Malaise]]
* [[Anorexia]]
* [[Weight loss]]
* [[Cough]] (90% cases) - nonproductive at the outset, more frequent during the morning, that gradually progresses to [[productive cough]], with [[purulent]] sputum, with occasional streaks of blood
* [[Hemoptysis]] (20-30% cases) may occur in the following cases:
:*Rupture of a [[blood vessel]] on a cavity wall (severe [[hemoptysis]])
:*Rupture of a [[pulmonary artery]] [[aneurysm]] adjacent or within a tuberculous cavity ([[Rasmussen's aneurysm]])
:*Rupture of a [[pulmonary artery]] [[aneurysm]] adjacent or within a tuberculous cavity ([[Rasmussen's aneurysm]])
:*Formation of an [[aspergilloma]] in a lung cavity
:*Formation of an [[aspergilloma]] in a lung cavity
* [[Pleuritic chest pain]]
 
* [[Dyspnea]] (in severe disease)
*[[Pleuritic chest pain]]
* [[ARDS]]
*[[Dyspnea]] (in severe disease)
*[[ARDS]]


==Complications==
==Complications==
Tuberculosis may be localized to the [[lungs]], or involve other organs and regions of the body.  Pulmonary TB may lead to permanent damage of the lungs and affected structures.  Depending on the pulmonary, or extrapulmonary nature of the lesions, potential [[complications]] that may arise include:<ref name="pmid11452057">{{cite journal| author=Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH| title=Thoracic sequelae and complications of tuberculosis. | journal=Radiographics | year= 2001 | volume= 21 | issue= 4 | pages= 839-58; discussion 859-60 | pmid=11452057 | doi=10.1148/radiographics.21.4.g01jl06839 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11452057  }} </ref><ref name=PubMed>{{cite web | title = Prognosis of TB | url = http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001141/ }}</ref>
[[Tuberculosis]] may be localized to the [[lungs]], or affects other organs of the body.  [[Tuberculosis|Pulmonary TB]] can result in permanent damage of the [[Lung|lungs]] and affected organs.  According to the [[Lung|pulmonary]], or [[Extrapulmonary tuberculosis|extrapulmonary]] nature of the lesions, the possible [[complications]] may include:<ref name="pmid11452057">{{cite journal| author=Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH| title=Thoracic sequelae and complications of tuberculosis. | journal=Radiographics | year= 2001 | volume= 21 | issue= 4 | pages= 839-58; discussion 859-60 | pmid=11452057 | doi=10.1148/radiographics.21.4.g01jl06839 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11452057  }} </ref><ref name="PubMed">{{cite web | title = Prognosis of TB | url = http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001141/ }}</ref>
===Parenchymal Lesions===
===Parenchymal Lesions===
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center;" width="700px"
|valign=top|
| valign="top" |
|+
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Complication}}
! style="background: #4479BA; width: 100px;" |{{fontcolor|#FFF|Complication}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Description}}
! style="background: #4479BA; width: 600px;" |{{fontcolor|#FFF|Description}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Tuberculoma]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Tuberculoma]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* Single or multiple lesions of > 0.5 cm
*Single or multiple lesions of > 0.5 cm
* May occur in primary or secundary TB
*May occur in primary or secondary TB
* Main finding on the [[chest X-ray]] in 5% of the cases of secondary TB<ref name="pmid3484866">{{cite journal| author=Woodring JH, Vandiviere HM, Fried AM, Dillon ML, Williams TD, Melvin IG| title=Update: the radiographic features of pulmonary tuberculosis. | journal=AJR Am J Roentgenol | year= 1986 | volume= 146 | issue= 3 | pages= 497-506 | pmid=3484866 | doi=10.2214/ajr.146.3.497 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3484866  }} </ref>
*Main finding on the [[chest X-ray]] in 5% of the cases of secondary TB<ref name="pmid3484866">{{cite journal| author=Woodring JH, Vandiviere HM, Fried AM, Dillon ML, Williams TD, Melvin IG| title=Update: the radiographic features of pulmonary tuberculosis. | journal=AJR Am J Roentgenol | year= 1986 | volume= 146 | issue= 3 | pages= 497-506 | pmid=3484866 | doi=10.2214/ajr.146.3.497 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3484866  }} </ref>
* Caused by [[inflammatory]] or [[connective tissue]] surrounding [[M. tuberculosis]]<ref name="pmid8456658">{{cite journal| author=Lee KS, Song KS, Lim TH, Kim PN, Kim IY, Lee BH| title=Adult-onset pulmonary tuberculosis: findings on chest radiographs and CT scans. | journal=AJR Am J Roentgenol | year= 1993 | volume= 160 | issue= 4 | pages= 753-8 | pmid=8456658 | doi=10.2214/ajr.160.4.8456658 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8456658  }} </ref><ref name="pmid472765">{{cite journal| author=Palmer PE| title=Pulmonary tuberculosis--usual and unusual radiographic presentations. | journal=Semin Roentgenol | year= 1979 | volume= 14 | issue= 3 | pages= 204-43 | pmid=472765 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=472765  }} </ref><ref name="pmid3484866">{{cite journal| author=Woodring JH, Vandiviere HM, Fried AM, Dillon ML, Williams TD, Melvin IG| title=Update: the radiographic features of pulmonary tuberculosis. | journal=AJR Am J Roentgenol | year= 1986 | volume= 146 | issue= 3 | pages= 497-506 | pmid=3484866 | doi=10.2214/ajr.146.3.497 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3484866  }} </ref>
*Caused by [[inflammatory]] or [[connective tissue]] surrounding [[M. tuberculosis]]<ref name="pmid8456658">{{cite journal| author=Lee KS, Song KS, Lim TH, Kim PN, Kim IY, Lee BH| title=Adult-onset pulmonary tuberculosis: findings on chest radiographs and CT scans. | journal=AJR Am J Roentgenol | year= 1993 | volume= 160 | issue= 4 | pages= 753-8 | pmid=8456658 | doi=10.2214/ajr.160.4.8456658 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8456658  }} </ref><ref name="pmid472765">{{cite journal| author=Palmer PE| title=Pulmonary tuberculosis--usual and unusual radiographic presentations. | journal=Semin Roentgenol | year= 1979 | volume= 14 | issue= 3 | pages= 204-43 | pmid=472765 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=472765  }} </ref><ref name="pmid3484866">{{cite journal| author=Woodring JH, Vandiviere HM, Fried AM, Dillon ML, Williams TD, Melvin IG| title=Update: the radiographic features of pulmonary tuberculosis. | journal=AJR Am J Roentgenol | year= 1986 | volume= 146 | issue= 3 | pages= 497-506 | pmid=3484866 | doi=10.2214/ajr.146.3.497 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3484866  }} </ref>
* The center of the [[tuberculoma]] is often [[necrotic]]  
*The center of the [[tuberculoma]] is often [[necrotic]]
* Satellite lesions in 80% of the cases
*Satellite lesions in 80% of the cases
* Nodular or diffused calcifications in 20-30% of the cases<ref name="pmid8456658">{{cite journal| author=Lee KS, Song KS, Lim TH, Kim PN, Kim IY, Lee BH| title=Adult-onset pulmonary tuberculosis: findings on chest radiographs and CT scans. | journal=AJR Am J Roentgenol | year= 1993 | volume= 160 | issue= 4 | pages= 753-8 | pmid=8456658 | doi=10.2214/ajr.160.4.8456658 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8456658  }} </ref>
*Nodular or diffused calcifications in 20-30% of the cases<ref name="pmid8456658">{{cite journal| author=Lee KS, Song KS, Lim TH, Kim PN, Kim IY, Lee BH| title=Adult-onset pulmonary tuberculosis: findings on chest radiographs and CT scans. | journal=AJR Am J Roentgenol | year= 1993 | volume= 160 | issue= 4 | pages= 753-8 | pmid=8456658 | doi=10.2214/ajr.160.4.8456658 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8456658  }} </ref>
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Cicatrization
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Cicatrization
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* Common in secondary TB
*Common in secondary TB
* Marked [[fibrosis]] in ≤40% of secondary TB cases, which may present as:
*Marked [[fibrosis]] in ≤40% of secondary TB cases, which may present as:
 
:*Upper lobe [[atelectasis]]
:*Upper lobe [[atelectasis]]
:*Compensatory hyperinflation of the lower lobe
:*Compensatory hyperinflation of the lower lobe
:*[[Hilar]] retraction
:*[[Hilar]] retraction
:*[[Mediastinal]] shift
:*[[Mediastinal]] shift
* Unspecific [[X-Ray]] findings may include:<ref name="pmid11452057">{{cite journal| author=Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH| title=Thoracic sequelae and complications of tuberculosis. | journal=Radiographics | year= 2001 | volume= 21 | issue= 4 | pages= 839-58; discussion 859-60 | pmid=11452057 | doi=10.1148/radiographics.21.4.g01jl06839 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11452057  }} </ref>
 
*Unspecific [[X-Ray]] findings may include:<ref name="pmid11452057">{{cite journal| author=Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH| title=Thoracic sequelae and complications of tuberculosis. | journal=Radiographics | year= 2001 | volume= 21 | issue= 4 | pages= 839-58; discussion 859-60 | pmid=11452057 | doi=10.1148/radiographics.21.4.g01jl06839 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11452057  }} </ref>
 
:*Parenchymal bands
:*Parenchymal bands
:*Fibrotic cavities
:*Fibrotic cavities
Line 76: Line 83:
:*Traction [[bronchiectasis]]
:*Traction [[bronchiectasis]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Thin-walled cavity
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Thin-walled cavity
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* Present in active and inactive forms of the disease
*Found in both the active and inactive forms of the disease
* May regress with treatment
*May regress with treatment
* Air-filled [[cysts]] may persist<ref>{{cite book | last = Fraser | first = Richard | title = Synopsis of diseases of the chest | publisher = W.B. Saunders | location = Philadelphia | year = 1994 | isbn = 0721636691 }}</ref>
*Air-filled [[cysts]] may persist<ref>{{cite book | last = Fraser | first = Richard | title = Synopsis of diseases of the chest | publisher = W.B. Saunders | location = Philadelphia | year = 1994 | isbn = 0721636691 }}</ref>
* May be misidentified as an [[Emphysema|emphysematous]] bulla or pneumatocelle.
*Maybe misidentified as an [[Emphysema|emphysematous]] bulla or pneumatocele.
|-
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Aspergilloma]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Aspergilloma]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Mass of [[hyphae]], cell debris and [[mucus]], commonly located in a cavity or [[bronchus]]<ref name="pmid8744521">{{cite journal| author=Logan PM, Müller NL| title=CT manifestations of pulmonary aspergillosis. | journal=Crit Rev Diagn Imaging | year= 1996 | volume= 37 | issue= 1 | pages= 1-37 | pmid=8744521 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8744521  }} </ref><ref name="pmid8838945">{{cite journal| author=Miller WT| title=Aspergillosis: a disease with many faces. | journal=Semin Roentgenol | year= 1996 | volume= 31 | issue= 1 | pages= 52-66 | pmid=8838945 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8838945  }} </ref><ref name="pmid8577955">{{cite journal| author=Thompson BH, Stanford W, Galvin JR, Kurihara Y| title=Varied radiologic appearances of pulmonary aspergillosis. | journal=Radiographics | year= 1995 | volume= 15 | issue= 6 | pages= 1273-84 | pmid=8577955 | doi=10.1148/radiographics.15.6.8577955 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8577955  }} </ref>
*Mass of [[hyphae]], cell debris and [[mucus]], usually present in a cavity or [[bronchus]]<ref name="pmid8744521">{{cite journal| author=Logan PM, Müller NL| title=CT manifestations of pulmonary aspergillosis. | journal=Crit Rev Diagn Imaging | year= 1996 | volume= 37 | issue= 1 | pages= 1-37 | pmid=8744521 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8744521  }} </ref><ref name="pmid8838945">{{cite journal| author=Miller WT| title=Aspergillosis: a disease with many faces. | journal=Semin Roentgenol | year= 1996 | volume= 31 | issue= 1 | pages= 52-66 | pmid=8838945 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8838945  }} </ref><ref name="pmid8577955">{{cite journal| author=Thompson BH, Stanford W, Galvin JR, Kurihara Y| title=Varied radiologic appearances of pulmonary aspergillosis. | journal=Radiographics | year= 1995 | volume= 15 | issue= 6 | pages= 1273-84 | pmid=8577955 | doi=10.1148/radiographics.15.6.8577955 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8577955  }} </ref>
*Previous history of chronic cavitary TB in 25-55% of cases presenting with [[aspergilloma]]
*Previous history of chronic cavitary TB in 25-55% of cases presenting with [[aspergilloma]]
*Frequently concomitant with [[hemoptysis]] in 50-90% of the cases
*Often occurs with [[hemoptysis]] in 50-90% of the cases
*[[X-ray]] shows a mobile mass ringed by an air shadow
*[[X-ray]] reveals a mobile mass ringed by an air shadow
*[[CT]] shows a mobile mass, generally interspaced with air shadows
*[[CT]] reveals a mobile mass, generally interspaced with air shadows
*May be calcified
*Maybe calcified
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Lung destruction<ref name="pmid11452057">{{cite journal| author=Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH| title=Thoracic sequelae and complications of tuberculosis. | journal=Radiographics | year= 2001 | volume= 21 | issue= 4 | pages= 839-58; discussion 859-60 | pmid=11452057 | doi=10.1148/radiographics.21.4.g01jl06839 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11452057  }} </ref>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Lung destruction<ref name="pmid11452057">{{cite journal| author=Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH| title=Thoracic sequelae and complications of tuberculosis. | journal=Radiographics | year= 2001 | volume= 21 | issue= 4 | pages= 839-58; discussion 859-60 | pmid=11452057 | doi=10.1148/radiographics.21.4.g01jl06839 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11452057  }} </ref>
Line 101: Line 108:
*Complicates assessment of TB activity in the lung with the [[chest X-ray]]
*Complicates assessment of TB activity in the lung with the [[chest X-ray]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Bronchogenic carcinoma]]<ref name="pmid11452057">{{cite journal| author=Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH| title=Thoracic sequelae and complications of tuberculosis. | journal=Radiographics | year= 2001 | volume= 21 | issue= 4 | pages= 839-58; discussion 859-60 | pmid=11452057 | doi=10.1148/radiographics.21.4.g01jl06839 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11452057  }} </ref>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Bronchogenic carcinoma]]<ref name="pmid11452057">{{cite journal| author=Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH| title=Thoracic sequelae and complications of tuberculosis. | journal=Radiographics | year= 2001 | volume= 21 | issue= 4 | pages= 839-58; discussion 859-60 | pmid=11452057 | doi=10.1148/radiographics.21.4.g01jl06839 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11452057  }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*May be misinterpreted as TB progression
*Maybe misinterpreted as TB progression
*Scar formation in TB may lead to carcinoma
*Scar formation in TB may lead to carcinoma
*May cause reactivation of TB<ref name="pmid4975011">{{cite journal| author=Snider GL, Placik B| title=The relationship between pulmonary tuberculosis and bronchogenic carcinoma. A topographic study. | journal=Am Rev Respir Dis | year= 1969 | volume= 99 | issue= 2 | pages= 229-36 | pmid=4975011 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4975011  }} </ref><ref name="pmid1265261">{{cite journal| author=Ting YM, Church WR, Ravikrishnan KP| title=Lung carcinoma superimposed on pulmonary tuberculosis. | journal=Radiology | year= 1976 | volume= 119 | issue= 2 | pages= 307-12 | pmid=1265261 | doi=10.1148/119.2.307 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1265261  }} </ref>
*May cause reactivation of TB<ref name="pmid4975011">{{cite journal| author=Snider GL, Placik B| title=The relationship between pulmonary tuberculosis and bronchogenic carcinoma. A topographic study. | journal=Am Rev Respir Dis | year= 1969 | volume= 99 | issue= 2 | pages= 229-36 | pmid=4975011 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4975011  }} </ref><ref name="pmid1265261">{{cite journal| author=Ting YM, Church WR, Ravikrishnan KP| title=Lung carcinoma superimposed on pulmonary tuberculosis. | journal=Radiology | year= 1976 | volume= 119 | issue= 2 | pages= 307-12 | pmid=1265261 | doi=10.1148/119.2.307 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1265261  }} </ref>
Line 110: Line 117:


===Airway Lesions===
===Airway Lesions===
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center;" width="700px"
|valign=top|
| valign="top" |
|+
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Complication}}
! style="background: #4479BA; width: 100px;" |{{fontcolor|#FFF|Complication}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Description}}
! style="background: #4479BA; width: 600px;" |{{fontcolor|#FFF|Description}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Bronchiectasis
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Bronchiectasis
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Result from the [[bronchial]] wall involvement, with [[fibrosis]], and secondary [[bronchial]] dilation, often called traction [[bronchiectasis]]
*It occurs due to the [[bronchial]] wall involvement, with [[fibrosis]], and secondary [[bronchial]] dilation, often called traction [[bronchiectasis]]
*Identified on [[CT]] in 30-60% of cases of secondary TB, and in 71-86% of cases of inactive TB<ref name="pmid8874255">{{cite journal| author=Lee KS, Hwang JW, Chung MP, Kim H, Kwon OJ| title=Utility of CT in the evaluation of pulmonary tuberculosis in patients without AIDS. | journal=Chest | year= 1996 | volume= 110 | issue= 4 | pages= 977-84 | pmid=8874255 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8874255  }} </ref><ref name="pmid8733492">{{cite journal| author=Hatipoğlu ON, Osma E, Manisali M, Uçan ES, Balci P, Akkoçlu A et al.| title=High resolution computed tomographic findings in pulmonary tuberculosis. | journal=Thorax | year= 1996 | volume= 51 | issue= 4 | pages= 397-402 | pmid=8733492 | doi= | pmc=PMC1090675 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8733492  }} </ref>
*Identified on [[CT]] in 30-60% of cases of secondary TB, and in 71-86% of cases of inactive TB<ref name="pmid8874255">{{cite journal| author=Lee KS, Hwang JW, Chung MP, Kim H, Kwon OJ| title=Utility of CT in the evaluation of pulmonary tuberculosis in patients without AIDS. | journal=Chest | year= 1996 | volume= 110 | issue= 4 | pages= 977-84 | pmid=8874255 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8874255  }} </ref><ref name="pmid8733492">{{cite journal| author=Hatipoğlu ON, Osma E, Manisali M, Uçan ES, Balci P, Akkoçlu A et al.| title=High resolution computed tomographic findings in pulmonary tuberculosis. | journal=Thorax | year= 1996 | volume= 51 | issue= 4 | pages= 397-402 | pmid=8733492 | doi= | pmc=PMC1090675 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8733492  }} </ref>
*Highly suggestive of TB when located at the apical-posterior segment of the lung
*Indicative of TB when located at the apical-posterior segment of the lung
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Tracheobronchial stenosis
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Tracheobronchial stenosis
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Predominance on the left main [[bronchus]]
*Predominance on the left main [[bronchus]]
*Caused by:
*Caused by:
:*[[Granulomatous]] tracheobronchial wall changes
:*[[Granulomatous]] tracheobronchial wall changes
:*Enlargement of peribronchial [[lymph nodes]] pressing on the tracheobronchial wall
:*Enlargement of peribronchial [[lymph nodes]] pressing on the tracheobronchial wall
*Endobronchial involvement in 2-4% of the cases
*Endobronchial involvement in 2-4% of the cases
*Tracheobronchial narrowing from the formation of intraluminal granulation tissue
*Tracheobronchial narrowing from the formation of intraluminal granulation tissue
*[[CT scan]] findings may include:
*[[CT scan]] findings may include:
:*Uniform wall thickening
:*Uniform wall thickening
:*[[Mediastinal]] [[lymph node]] enlargement
:*[[Mediastinal]] [[lymph node]] enlargement
:*Concentrical luminal narrowing
:*Concentrical luminal narrowing
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Broncholithiasis
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Broncholithiasis
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Rare complication
*Rare complication
*Calcified material within the tracheobronchial lumen, originated on a calcified [[lymph node]]<ref name="pmid2371439">{{cite journal| author=Galdermans D, Verhaert J, Van Meerbeeck J, de Backer W, Vermeire P| title=Broncholithiasis: present clinical spectrum. | journal=Respir Med | year= 1990 | volume= 84 | issue= 2 | pages= 155-6 | pmid=2371439 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2371439  }} </ref>
*Calcified material within the tracheobronchial lumen, originated on a calcified [[lymph node]]<ref name="pmid2371439">{{cite journal| author=Galdermans D, Verhaert J, Van Meerbeeck J, de Backer W, Vermeire P| title=Broncholithiasis: present clinical spectrum. | journal=Respir Med | year= 1990 | volume= 84 | issue= 2 | pages= 155-6 | pmid=2371439 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2371439  }} </ref>
*Recurrent [[pneumonia]] and [[hemoptysis]] are frequent in [[broncholithiasis]]<ref name="pmid2371439">{{cite journal| author=Galdermans D, Verhaert J, Van Meerbeeck J, de Backer W, Vermeire P| title=Broncholithiasis: present clinical spectrum. | journal=Respir Med | year= 1990 | volume= 84 | issue= 2 | pages= 155-6 | pmid=2371439 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2371439  }} </ref><ref name="pmid6833568">{{cite journal| author=Kowal LE, Goodman LR, Zarro VJ, Haskin ME| title=CT diagnosis of broncholithiasis. | journal=J Comput Assist Tomogr | year= 1983 | volume= 7 | issue= 2 | pages= 321-3 | pmid=6833568 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6833568  }} </ref><ref name="pmid1853800">{{cite journal| author=Conces DJ, Tarver RD, Vix VA| title=Broncholithiasis: CT features in 15 patients. | journal=AJR Am J Roentgenol | year= 1991 | volume= 157 | issue= 2 | pages= 249-53 | pmid=1853800 | doi=10.2214/ajr.157.2.1853800 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1853800  }} </ref>
*Recurrent [[pneumonia]] and [[hemoptysis]] are frequent in broncholithiasis<ref name="pmid2371439">{{cite journal| author=Galdermans D, Verhaert J, Van Meerbeeck J, de Backer W, Vermeire P| title=Broncholithiasis: present clinical spectrum. | journal=Respir Med | year= 1990 | volume= 84 | issue= 2 | pages= 155-6 | pmid=2371439 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2371439  }} </ref><ref name="pmid6833568">{{cite journal| author=Kowal LE, Goodman LR, Zarro VJ, Haskin ME| title=CT diagnosis of broncholithiasis. | journal=J Comput Assist Tomogr | year= 1983 | volume= 7 | issue= 2 | pages= 321-3 | pmid=6833568 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6833568  }} </ref><ref name="pmid1853800">{{cite journal| author=Conces DJ, Tarver RD, Vix VA| title=Broncholithiasis: CT features in 15 patients. | journal=AJR Am J Roentgenol | year= 1991 | volume= 157 | issue= 2 | pages= 249-53 | pmid=1853800 | doi=10.2214/ajr.157.2.1853800 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1853800  }} </ref>
*On the [[chest X-ray]], common findings may include:
*On the [[chest X-ray]], common findings may include:
:*[[Airway]] obstruction
:*[[Airway]] obstruction
:*[[Atelectasis]]
:*[[Atelectasis]]
:*[[Air trapping]] on expiration
:*[[Air trapping]] on the expiration
:*Frequent change in position of the calcified material
:*Frequent change in position of the calcified material
:*Mucoid impaction
:*Mucoid impaction
*[[CT]] scan findings may include:<ref name="pmid6833568">{{cite journal| author=Kowal LE, Goodman LR, Zarro VJ, Haskin ME| title=CT diagnosis of broncholithiasis. | journal=J Comput Assist Tomogr | year= 1983 | volume= 7 | issue= 2 | pages= 321-3 | pmid=6833568 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6833568  }} </ref><ref name="pmid1853800">{{cite journal| author=Conces DJ, Tarver RD, Vix VA| title=Broncholithiasis: CT features in 15 patients. | journal=AJR Am J Roentgenol | year= 1991 | volume= 157 | issue= 2 | pages= 249-53 | pmid=1853800 | doi=10.2214/ajr.157.2.1853800 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1853800  }} </ref>
*[[CT]] scan findings may include:<ref name="pmid6833568">{{cite journal| author=Kowal LE, Goodman LR, Zarro VJ, Haskin ME| title=CT diagnosis of broncholithiasis. | journal=J Comput Assist Tomogr | year= 1983 | volume= 7 | issue= 2 | pages= 321-3 | pmid=6833568 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6833568  }} </ref><ref name="pmid1853800">{{cite journal| author=Conces DJ, Tarver RD, Vix VA| title=Broncholithiasis: CT features in 15 patients. | journal=AJR Am J Roentgenol | year= 1991 | volume= 157 | issue= 2 | pages= 249-53 | pmid=1853800 | doi=10.2214/ajr.157.2.1853800 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1853800  }} </ref>
:*Endo or peribronchial calcified [[lymph node]]s
:*Endo or peribronchial calcified [[lymph node]]s
:*[[Atelectasis]]
:*[[Atelectasis]]
Line 154: Line 167:


===Vascular Lesions===
===Vascular Lesions===
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center;" width="700px"
|valign=top|
| valign="top" |
|+
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Complication}}
! style="background: #4479BA; width: 100px;" |{{fontcolor|#FFF|Complication}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Description}}
! style="background: #4479BA; width: 600px;" |{{fontcolor|#FFF|Description}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Pulmonary or bronchial [[arteritis]] and [[thrombosis]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Pulmonary or bronchial [[arteritis]] and [[thrombosis]]
  | style="padding: 5px 5px; background: #F5F5F5;" |
  | style="padding: 5px 5px; background: #F5F5F5;" |
*Perform acid-fast staining whenever in presence of [[necrotizing]] [[granulomatous]] pulmonary [[vasculitis]] to rule out TB<ref>{{cite book | last = Fraser | first = Richard | title = Synopsis of diseases of the chest | publisher = W.B. Saunders | location = Philadelphia | year = 1994 | isbn = 0721636691 }}</ref>
*Perform acid-fast staining whenever in presence of [[necrotizing]] [[granulomatous]] pulmonary [[vasculitis]] to rule out TB<ref>{{cite book | last = Fraser | first = Richard | title = Synopsis of diseases of the chest | publisher = W.B. Saunders | location = Philadelphia | year = 1994 | isbn = 0721636691 }}</ref>
Line 177: Line 190:


===Mediastinal Lesions===
===Mediastinal Lesions===
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center;" width="700px"
|valign=top|
| valign="top" |
|+
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Complication}}
! style="background: #4479BA; width: 100px;" |{{fontcolor|#FFF|Complication}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Description}}
! style="background: #4479BA; width: 600px;" |{{fontcolor|#FFF|Description}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Esophagobronchial [[fistula]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Esophagobronchial [[fistula]]
Line 192: Line 205:
*Complication of [[tuberculous lymphadenitis]]
*Complication of [[tuberculous lymphadenitis]]
*May  lead to:<ref>{{cite book | last = Fraser | first = Richard | title = Synopsis of diseases of the chest | publisher = W.B. Saunders | location = Philadelphia | year = 1994 | isbn = 0721636691 }}</ref><ref name="pmid7801924">{{cite journal| author=Mönig SP, Schmidt R, Wolters U, Krug B| title=Esophageal tuberculosis: a differential diagnostic challenge. | journal=Am J Gastroenterol | year= 1995 | volume= 90 | issue= 1 | pages= 153-4 | pmid=7801924 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7801924  }} </ref>
*May  lead to:<ref>{{cite book | last = Fraser | first = Richard | title = Synopsis of diseases of the chest | publisher = W.B. Saunders | location = Philadelphia | year = 1994 | isbn = 0721636691 }}</ref><ref name="pmid7801924">{{cite journal| author=Mönig SP, Schmidt R, Wolters U, Krug B| title=Esophageal tuberculosis: a differential diagnostic challenge. | journal=Am J Gastroenterol | year= 1995 | volume= 90 | issue= 1 | pages= 153-4 | pmid=7801924 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7801924  }} </ref>
:*[[Strictures]]
:*[[Strictures]]
:*[[Mediastinal]] or [[tracheobronchial]] fistulas
:*[[Mediastinal]] or [[tracheobronchial]] fistulas
:*Traction diverticulae
:*Traction diverticula
 
*Common [[symptoms]] include:<ref name="pmid2299003">{{cite journal| author=Im JG, Kim JH, Han MC, Kim CW| title=Computed tomography of esophagomediastinal fistula in tuberculous mediastinal lymphadenitis. | journal=J Comput Assist Tomogr | year= 1990 | volume= 14 | issue= 1 | pages= 89-92 | pmid=2299003 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2299003  }} </ref>
*Common [[symptoms]] include:<ref name="pmid2299003">{{cite journal| author=Im JG, Kim JH, Han MC, Kim CW| title=Computed tomography of esophagomediastinal fistula in tuberculous mediastinal lymphadenitis. | journal=J Comput Assist Tomogr | year= 1990 | volume= 14 | issue= 1 | pages= 89-92 | pmid=2299003 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2299003  }} </ref>
:*[[Fever]]
:*[[Fever]]
:*[[Cough]]
:*[[Cough]]
Line 202: Line 218:
:*[[Chest discomfort]]
:*[[Chest discomfort]]
:*[[Back pain]]
:*[[Back pain]]
*Common envolvement of the subcarinal region
 
*Common involvement of the subcarinal region
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Constrictive pericarditis]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Constrictive pericarditis]]
Line 209: Line 226:
*Frequently caused by extension of tuberculous lymphadenitis
*Frequently caused by extension of tuberculous lymphadenitis
*May occur in [[miliary TB]]<ref name="pmid8456658">{{cite journal| author=Lee KS, Song KS, Lim TH, Kim PN, Kim IY, Lee BH| title=Adult-onset pulmonary tuberculosis: findings on chest radiographs and CT scans. | journal=AJR Am J Roentgenol | year= 1993 | volume= 160 | issue= 4 | pages= 753-8 | pmid=8456658 | doi=10.2214/ajr.160.4.8456658 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8456658  }} </ref>
*May occur in [[miliary TB]]<ref name="pmid8456658">{{cite journal| author=Lee KS, Song KS, Lim TH, Kim PN, Kim IY, Lee BH| title=Adult-onset pulmonary tuberculosis: findings on chest radiographs and CT scans. | journal=AJR Am J Roentgenol | year= 1993 | volume= 160 | issue= 4 | pages= 753-8 | pmid=8456658 | doi=10.2214/ajr.160.4.8456658 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8456658  }} </ref>
*Common findings on [[CT]] include:
*Common findings on [[CT]] may include:
 
:*[[Lymphadenopathy]]
:*[[Lymphadenopathy]]
:*[[Pericardial]] thickening
:*[[Pericardial]] thickening
:*[[Pericardial effusion]] may be present
:*[[Pericardial effusion]] may be present
*10% of cases of [[tuberculous pericarditis]] complicate into [[constrictive pericarditis]]
*10% of cases of [[tuberculous pericarditis]] complicate into [[constrictive pericarditis]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Lymph node]] calcification
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Lymph node]] calcification
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*83-96% of pediatric cases occur with lymphadenopathy<ref name="pmid8516692">{{cite journal| author=Agrons GA, Markowitz RI, Kramer SS| title=Pulmonary tuberculosis in children. | journal=Semin Roentgenol | year= 1993 | volume= 28 | issue= 2 | pages= 158-72 | pmid=8516692 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8516692  }} </ref><ref name="pmid1727316">{{cite journal| author=Leung AN, Müller NL, Pineda PR, FitzGerald JM| title=Primary tuberculosis in childhood: radiographic manifestations. | journal=Radiology | year= 1992 | volume= 182 | issue= 1 | pages= 87-91 | pmid=1727316 | doi=10.1148/radiology.182.1.1727316 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1727316  }} </ref><ref name="pmid6867325">{{cite journal| author=Choyke PL, Sostman HD, Curtis AM, Ravin CE, Chen JT, Godwin JD et al.| title=Adult-onset pulmonary tuberculosis. | journal=Radiology | year= 1983 | volume= 148 | issue= 2 | pages= 357-62 | pmid=6867325 | doi=10.1148/radiology.148.2.6867325 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6867325  }} </ref>
*83-96% of pediatric cases occur with [[lymphadenopathy]]<ref name="pmid8516692">{{cite journal| author=Agrons GA, Markowitz RI, Kramer SS| title=Pulmonary tuberculosis in children. | journal=Semin Roentgenol | year= 1993 | volume= 28 | issue= 2 | pages= 158-72 | pmid=8516692 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8516692  }} </ref><ref name="pmid1727316">{{cite journal| author=Leung AN, Müller NL, Pineda PR, FitzGerald JM| title=Primary tuberculosis in childhood: radiographic manifestations. | journal=Radiology | year= 1992 | volume= 182 | issue= 1 | pages= 87-91 | pmid=1727316 | doi=10.1148/radiology.182.1.1727316 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1727316  }} </ref><ref name="pmid6867325">{{cite journal| author=Choyke PL, Sostman HD, Curtis AM, Ravin CE, Chen JT, Godwin JD et al.| title=Adult-onset pulmonary tuberculosis. | journal=Radiology | year= 1983 | volume= 148 | issue= 2 | pages= 357-62 | pmid=6867325 | doi=10.1148/radiology.148.2.6867325 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6867325  }} </ref>
*Commonly affected adults:<ref name="pmid7610236">{{cite journal| author=Hopewell PC| title=A clinical view of tuberculosis. | journal=Radiol Clin North Am | year= 1995 | volume= 33 | issue= 4 | pages= 641-53 | pmid=7610236 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7610236  }} </ref>
*Commonly affected adults:<ref name="pmid7610236">{{cite journal| author=Hopewell PC| title=A clinical view of tuberculosis. | journal=Radiol Clin North Am | year= 1995 | volume= 33 | issue= 4 | pages= 641-53 | pmid=7610236 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7610236  }} </ref>
:*Pubertal women
:*Pubertal women
:*Elderly
:*Elderly
:*Immunosuppressed patients
:*[[Immunosuppressed]] patients
*[[Caseating]] [[granulomas]], cause [[mediastinal]] [[lymphadenitis]], which occurs more often on the right side.
 
*Affected [[lymph node]]s show central attenuation ([[caseating]] material) and peripheral enhancement (hypervascularity and inflammatory reaction) on CT.
*[[Caseating]] [[granulomas]], cause [[mediastinal]] [[lymphadenitis]] (predominantly on the right side)
*Affected [[lymph node]]s show central attenuation ([[caseating]] material) and peripheral enhancement (hypervascularity and [[inflammatory]] reaction) on [[CT]].
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Fibrosing [[mediastinitis]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Fibrosing [[mediastinitis]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Rare<ref name="pmid11428422">{{cite journal| author=Atasoy C, Fitoz S, Erguvan B, Akyar S| title=Tuberculous fibrosing mediastinitis: CT and MRI findings. | journal=J Thorac Imaging | year= 2001 | volume= 16 | issue= 3 | pages= 191-3 | pmid=11428422 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11428422  }} </ref>
*Rare<ref name="pmid11428422">{{cite journal| author=Atasoy C, Fitoz S, Erguvan B, Akyar S| title=Tuberculous fibrosing mediastinitis: CT and MRI findings. | journal=J Thorac Imaging | year= 2001 | volume= 16 | issue= 3 | pages= 191-3 | pmid=11428422 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11428422  }} </ref>
*May present with mild symptoms, such as:


*May present with mild symptoms, such as:
:*Low-grade [[fever]]
:*Low-grade [[fever]]
:*[[Cough]]
:*[[Cough]]
:*Related to compression of neighboring structures (airways, esophagus and superior vena cava)<ref name="pmid7790546">{{cite journal| author=Kushihashi T, Munechika H, Motoya H, Hamada K, Satoh I, Naitoh H et al.| title=CT and MR findings in tuberculous mediastinitis. | journal=J Comput Assist Tomogr | year= 1995 | volume= 19 | issue= 3 | pages= 379-82 | pmid=7790546 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7790546  }} </ref>
:*Related to compression of neighboring structures ([[airways]], [[esophagus]] and [[superior vena cava]])<ref name="pmid7790546">{{cite journal| author=Kushihashi T, Munechika H, Motoya H, Hamada K, Satoh I, Naitoh H et al.| title=CT and MR findings in tuberculous mediastinitis. | journal=J Comput Assist Tomogr | year= 1995 | volume= 19 | issue= 3 | pages= 379-82 | pmid=7790546 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7790546  }} </ref>
*Granulomas may lead to fibrosing mediastinitis<ref name="pmid11428422">{{cite journal| author=Atasoy C, Fitoz S, Erguvan B, Akyar S| title=Tuberculous fibrosing mediastinitis: CT and MRI findings. | journal=J Thorac Imaging | year= 2001 | volume= 16 | issue= 3 | pages= 191-3 | pmid=11428422 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11428422  }} </ref>
 
*X-ray findings may include:
*[[Granulomas]] may lead to fibrosing [[mediastinitis]]<ref name="pmid11428422">{{cite journal| author=Atasoy C, Fitoz S, Erguvan B, Akyar S| title=Tuberculous fibrosing mediastinitis: CT and MRI findings. | journal=J Thorac Imaging | year= 2001 | volume= 16 | issue= 3 | pages= 191-3 | pmid=11428422 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11428422  }} </ref>
*[[Chest X-ray]] findings may include:
 
:*[[Mediastinal]] widening
:*[[Mediastinal]] widening
:*Localized mass
:*Localized mass
*CT findings may include:
 
:*Hilar or mediastinal mass
*[[CT]] findings may include:
 
:*[[Hilar]] or [[mediastinal]] mass
:*Calcification
:*Calcification
:*Tracheobronchial narrowing
:*[[Tracheobronchial]] narrowing
:*Obstruction of the [[superior vena cava]]
:*Obstruction of the [[superior vena cava]]
:*Pulmonary infiltrates
:*Pulmonary infiltrates
*May cause bronchial obstruction, and consequently:<ref name="pmid11428422">{{cite journal| author=Atasoy C, Fitoz S, Erguvan B, Akyar S| title=Tuberculous fibrosing mediastinitis: CT and MRI findings. | journal=J Thorac Imaging | year= 2001 | volume= 16 | issue= 3 | pages= 191-3 | pmid=11428422 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11428422  }} </ref><ref name="pmid7790546">{{cite journal| author=Kushihashi T, Munechika H, Motoya H, Hamada K, Satoh I, Naitoh H et al.| title=CT and MR findings in tuberculous mediastinitis. | journal=J Comput Assist Tomogr | year= 1995 | volume= 19 | issue= 3 | pages= 379-82 | pmid=7790546 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7790546  }} </ref>
*May cause bronchial obstruction, and consequently:<ref name="pmid11428422">{{cite journal| author=Atasoy C, Fitoz S, Erguvan B, Akyar S| title=Tuberculous fibrosing mediastinitis: CT and MRI findings. | journal=J Thorac Imaging | year= 2001 | volume= 16 | issue= 3 | pages= 191-3 | pmid=11428422 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11428422  }} </ref><ref name="pmid7790546">{{cite journal| author=Kushihashi T, Munechika H, Motoya H, Hamada K, Satoh I, Naitoh H et al.| title=CT and MR findings in tuberculous mediastinitis. | journal=J Comput Assist Tomogr | year= 1995 | volume= 19 | issue= 3 | pages= 379-82 | pmid=7790546 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7790546  }} </ref>
:*Obstructive [[pneumonia]]
:*Obstructive [[pneumonia]]
:*[[Atelectasis]]  
:*[[Atelectasis]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Extranodal extension
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Extranodal extension
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Commonly affects the following structures:
*Commonly affects the following structures:
:*[[Bronchus]]
:*[[Bronchus]]
:*[[Pericardium]]
:*[[Pericardium]]
Line 257: Line 284:


===Pleural Lesions===
===Pleural Lesions===
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center;" width="700px"
|valign=top|
| valign="top" |
|+
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Complication}}
! style="background: #4479BA; width: 100px;" |{{fontcolor|#FFF|Complication}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Description}}
! style="background: #4479BA; width: 600px;" |{{fontcolor|#FFF|Description}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Bronchopleural fistula]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Bronchopleural fistula]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*May occur:
*May occur:
:*Spontaneously
:*Spontaneously
:*After trauma
:*After trauma
:*After surgery
:*After surgery
*Associated with high a [[mortality rate]]:<ref name="pmid4683320">{{cite journal| author=Johnson TM, McCann W, Davey WN| title=Tuberculous bronchopleural fistula. | journal=Am Rev Respir Dis | year= 1973 | volume= 107 | issue= 1 | pages= 30-41 | pmid=4683320 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4683320  }} </ref>
*Associated with high a [[mortality rate]]:<ref name="pmid4683320">{{cite journal| author=Johnson TM, McCann W, Davey WN| title=Tuberculous bronchopleural fistula. | journal=Am Rev Respir Dis | year= 1973 | volume= 107 | issue= 1 | pages= 30-41 | pmid=4683320 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4683320  }} </ref>
:*Acute phase - due to toxicity, [[tension pneumothorax]], or disease spread
:*Acute phase - due to toxicity, [[tension pneumothorax]], or disease spread
:*Chronic phase - multiple seedings of [[bacteria]]
:*Chronic phase - multiple seedings of [[bacteria]]
*Diagnostic findings include:
*Diagnostic findings include:
:*Increased sputum production
:*Increased sputum production
:*Changes in the  air-fluid level
:*Changes in the  air-fluid level
Line 278: Line 310:
:*Spread of pneumonic infiltration to the contralateral lung
:*Spread of pneumonic infiltration to the contralateral lung
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Fibrothorax]] and chronic [[empyema]]  
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Fibrothorax]] and chronic [[empyema]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Pleural infection may occur following:<ref name="pmid6647852">{{cite journal| author=Hulnick DH, Naidich DP, McCauley DI| title=Pleural tuberculosis evaluated by computed tomography. | journal=Radiology | year= 1983 | volume= 149 | issue= 3 | pages= 759-65 | pmid=6647852 | doi=10.1148/radiology.149.3.6647852 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6647852  }} </ref><ref name="pmid8421723">{{cite journal| author=Müller NL| title=Imaging of the pleura. | journal=Radiology | year= 1993 | volume= 186 | issue= 2 | pages= 297-309 | pmid=8421723 | doi=10.1148/radiology.186.2.8421723 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8421723  }} </ref>
*Pleural infection may occur following:<ref name="pmid6647852">{{cite journal| author=Hulnick DH, Naidich DP, McCauley DI| title=Pleural tuberculosis evaluated by computed tomography. | journal=Radiology | year= 1983 | volume= 149 | issue= 3 | pages= 759-65 | pmid=6647852 | doi=10.1148/radiology.149.3.6647852 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6647852  }} </ref><ref name="pmid8421723">{{cite journal| author=Müller NL| title=Imaging of the pleura. | journal=Radiology | year= 1993 | volume= 186 | issue= 2 | pages= 297-309 | pmid=8421723 | doi=10.1148/radiology.186.2.8421723 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8421723  }} </ref>
:*Rupture of a subpleural focus of infection
:*Rupture of a subpleural focus of infection
:*[[Lymph node]] infection caused by hematogenous dissemination
:*[[Lymph node]] infection caused by hematogenous dissemination
*Chronic empyema may follow tuberculous pleurisy
 
*CT findings in chronic tuberculous empyema may include:
*Chronic [[empyema]] may follow tuberculous [[pleurisy]]
*CT findings in chronic tuberculous [[empyema]] may include:
 
:*Pleural thickening
:*Pleural thickening
:*Calcification
:*Calcification
*Disease inactivity is marked by absence of effusion with persistence of pleural thickening<ref name="pmid6647839">{{cite journal| author=Schmitt WG, Hübener KH, Rücker HC| title=Pleural calcification with persistent effusion. | journal=Radiology | year= 1983 | volume= 149 | issue= 3 | pages= 633-8 | pmid=6647839 | doi=10.1148/radiology.149.3.6647839 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6647839  }} </ref><ref name="pmid9017800">{{cite journal| author=Kuhlman JE, Singha NK| title=Complex disease of the pleural space: radiographic and CT evaluation. | journal=Radiographics | year= 1997 | volume= 17 | issue= 1 | pages= 63-79 | pmid=9017800 | doi=10.1148/radiographics.17.1.9017800 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9017800  }} </ref><ref name="pmidhttp://dx.doi.org/10.1148/radiology.175.1.2315473">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=http://dx.doi.org/10.1148/radiology.175.1.2315473 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }} </ref>
 
*Infected pleura may alter lipid and cholesterol transfer across the membrane causing lipid accumulation in the pleural fluid<ref name="pmid8331232">{{cite journal| author=Im JG, Chung JW, Han MC| title=Milk of calcium pleural collections: CT findings. | journal=J Comput Assist Tomogr | year= 1993 | volume= 17 | issue= 4 | pages= 613-6 | pmid=8331232 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8331232  }} </ref><ref name="pmid10924573">{{cite journal| author=Song JW, Im JG, Goo JM, Kim HY, Song CS, Lee JS| title=Pseudochylous pleural effusion with fat-fluid levels: report of six cases. | journal=Radiology | year= 2000 | volume= 216 | issue= 2 | pages= 478-80 | pmid=10924573 | doi=10.1148/radiology.216.2.r00jl09478 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10924573  }} </ref>
*Disease inactivity is marked by absence of [[pleural effusion|effusion]] with persistence of pleural thickening<ref name="pmid6647839">{{cite journal| author=Schmitt WG, Hübener KH, Rücker HC| title=Pleural calcification with persistent effusion. | journal=Radiology | year= 1983 | volume= 149 | issue= 3 | pages= 633-8 | pmid=6647839 | doi=10.1148/radiology.149.3.6647839 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6647839  }} </ref><ref name="pmid9017800">{{cite journal| author=Kuhlman JE, Singha NK| title=Complex disease of the pleural space: radiographic and CT evaluation. | journal=Radiographics | year= 1997 | volume= 17 | issue= 1 | pages= 63-79 | pmid=9017800 | doi=10.1148/radiographics.17.1.9017800 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9017800  }} </ref><ref name="pmidhttp://dx.doi.org/10.1148/radiology.175.1.2315473">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=http://dx.doi.org/10.1148/radiology.175.1.2315473 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }} </ref>
*Infected [[pleura]] may alter [[lipid]] and [[cholesterol]] transfer across the membrane, causing [[lipid]] accumulation in the [[pleural fluid]]<ref name="pmid8331232">{{cite journal| author=Im JG, Chung JW, Han MC| title=Milk of calcium pleural collections: CT findings. | journal=J Comput Assist Tomogr | year= 1993 | volume= 17 | issue= 4 | pages= 613-6 | pmid=8331232 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8331232  }} </ref><ref name="pmid10924573">{{cite journal| author=Song JW, Im JG, Goo JM, Kim HY, Song CS, Lee JS| title=Pseudochylous pleural effusion with fat-fluid levels: report of six cases. | journal=Radiology | year= 2000 | volume= 216 | issue= 2 | pages= 478-80 | pmid=10924573 | doi=10.1148/radiology.216.2.r00jl09478 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10924573  }} </ref>
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Pneumothorax]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Pneumothorax]]
Line 294: Line 330:
*Occurs in about 5% of patients with secondary TB
*Occurs in about 5% of patients with secondary TB
*Rare in [[miliary TB]]
*Rare in [[miliary TB]]
*In TB, it is present in severe lung disease
*Present in severe stages of tuberculous lung disease
*Commonly follows [[empyema]] and [[bronchopleural fistula]]
*Commonly follows [[empyema]] and [[bronchopleural fistula]]
*Consider active TB if after reexpansion, apical changes are noted  
*Consider active TB if, after reexpansion, apical changes are noted
|-
|-
|}
|}


===Chest Wall Lesions===
===Chest Wall Lesions===
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center;" width="700px"
|valign=top|
| valign="top" |
|+
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Complication}}
! style="background: #4479BA; width: 100px;" |{{fontcolor|#FFF|Complication}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Description}}
! style="background: #4479BA; width: 600px;" |{{fontcolor|#FFF|Description}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Tuberculous spondylitis ([[Pott's disease]])
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Tuberculous spondylitis ([[Pott's disease]])
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Hematogenous spread of pulmonary TB
*[[Blood|Hematogenous]] spread of pulmonary TB
*Commonly affected areas include:
*Commonly affected areas include:
:*Lower [[thoracic vertebrae]]
:*Lower [[thoracic vertebrae]]
:*Upper [[lumbar vertebrae]]
:*Upper [[lumbar vertebrae]]
*[[X-ray]] findings in the early stage of the disease may include:
*[[X-ray]] findings in the early stage of the disease may include:
:*Vertebral end plate irregularities
 
:*Vertebral endplate irregularities
:*Reduction of the intervertebral disk space
:*Reduction of the intervertebral disk space
:*Adjacent bone sclerosis
:*Adjacent bone sclerosis
*In later stages of the disease, [[kyphosis]], due to anterior compression of the [[vertebral bodies]], and paravertebral [[abscess]]es may occur
*In later stages of the disease, [[kyphosis]], due to anterior compression of the [[vertebral bodies]], and paravertebral [[abscess]]es may occur
*[[CT]] findings may include:<ref name="pmid9845453">{{cite journal| author=Ridley N, Shaikh MI, Remedios D, Mitchell R| title=Radiology of skeletal tuberculosis. | journal=Orthopedics | year= 1998 | volume= 21 | issue= 11 | pages= 1213-20 | pmid=9845453 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9845453  }} </ref><ref name="pmid7610245">{{cite journal| author=Sharif HS, Morgan JL, al Shahed MS, al Thagafi MY| title=Role of CT and MR imaging in the management of tuberculous spondylitis. | journal=Radiol Clin North Am | year= 1995 | volume= 33 | issue= 4 | pages= 787-804 | pmid=7610245 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7610245  }} </ref>
*[[CT]] findings may include:<ref name="pmid9845453">{{cite journal| author=Ridley N, Shaikh MI, Remedios D, Mitchell R| title=Radiology of skeletal tuberculosis. | journal=Orthopedics | year= 1998 | volume= 21 | issue= 11 | pages= 1213-20 | pmid=9845453 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9845453  }} </ref><ref name="pmid7610245">{{cite journal| author=Sharif HS, Morgan JL, al Shahed MS, al Thagafi MY| title=Role of CT and MR imaging in the management of tuberculous spondylitis. | journal=Radiol Clin North Am | year= 1995 | volume= 33 | issue= 4 | pages= 787-804 | pmid=7610245 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7610245  }} </ref>
:*Paravertebral abscess
:*Paravertebral abscess
:*Peripheral rim enhancement
:*Peripheral rim enhancement
Line 326: Line 367:
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*In the [[chest wall]], TB may involve:
*In the [[chest wall]], TB may involve:
:*[[Rib]]
:*[[Rib]]
:*[[Sternum]]
:*[[Sternum]]
:*[[Sternoclavicular joint]]
:*[[Sternoclavicular joint]]
*Characterized by:
*Characterized by:
:*[[Abscess]]es
:*[[Abscess]]es
:*Bone destruction
:*Bone destruction
:*Masses of the soft tissues, possibly calcified, which may, or may not show [[lung]] or [[pleural]] involvement at the CT scan<ref name="pmid8491894">{{cite journal| author=Lee G, Im JG, Kim JS, Kang HS, Han MC| title=Tuberculosis of the ribs: CT appearance. | journal=J Comput Assist Tomogr | year= 1993 | volume= 17 | issue= 3 | pages= 363-6 | pmid=8491894 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8491894  }} </ref><ref name="pmid8454753">{{cite journal| author=Adler BD, Padley SP, Müller NL| title=Tuberculosis of the chest wall: CT findings. | journal=J Comput Assist Tomogr | year= 1993 | volume= 17 | issue= 2 | pages= 271-3 | pmid=8454753 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8454753  }} </ref>
:*Masses of the soft tissues, possibly calcified, which may, or may not show [[lung]] or [[pleural]] involvement on the [[CT scan]]<ref name="pmid8491894">{{cite journal| author=Lee G, Im JG, Kim JS, Kang HS, Han MC| title=Tuberculosis of the ribs: CT appearance. | journal=J Comput Assist Tomogr | year= 1993 | volume= 17 | issue= 3 | pages= 363-6 | pmid=8491894 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8491894  }} </ref><ref name="pmid8454753">{{cite journal| author=Adler BD, Padley SP, Müller NL| title=Tuberculosis of the chest wall: CT findings. | journal=J Comput Assist Tomogr | year= 1993 | volume= 17 | issue= 2 | pages= 271-3 | pmid=8454753 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8454753  }} </ref>
 
*Chest wall bones and cartilages may be normal
*Chest wall bones and cartilages may be normal
*Hematogenous or direct dissemination from the infectious foci to the chest wall bone<ref name="pmid8491894">{{cite journal| author=Lee G, Im JG, Kim JS, Kang HS, Han MC| title=Tuberculosis of the ribs: CT appearance. | journal=J Comput Assist Tomogr | year= 1993 | volume= 17 | issue= 3 | pages= 363-6 | pmid=8491894 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8491894  }} </ref><ref name="pmid8454753">{{cite journal| author=Adler BD, Padley SP, Müller NL| title=Tuberculosis of the chest wall: CT findings. | journal=J Comput Assist Tomogr | year= 1993 | volume= 17 | issue= 2 | pages= 271-3 | pmid=8454753 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8454753  }} </ref>
*Hematogenous or direct dissemination from the [[infectious]] foci to the chest wall bone<ref name="pmid8491894">{{cite journal| author=Lee G, Im JG, Kim JS, Kang HS, Han MC| title=Tuberculosis of the ribs: CT appearance. | journal=J Comput Assist Tomogr | year= 1993 | volume= 17 | issue= 3 | pages= 363-6 | pmid=8491894 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8491894  }} </ref><ref name="pmid8454753">{{cite journal| author=Adler BD, Padley SP, Müller NL| title=Tuberculosis of the chest wall: CT findings. | journal=J Comput Assist Tomogr | year= 1993 | volume= 17 | issue= 2 | pages= 271-3 | pmid=8454753 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8454753  }} </ref>
*''Empyema necessitatis'' - [[subcutaneous]] [[abscess]] resulting from the discharge of an [[empyema]] through the [[parietal pleura]]<ref name="pmid2322879">{{cite journal| author=Glicklich M, Mendelson DS, Gendal ES, Teirstein AS| title=Tuberculous empyema necessitatis. Computed tomography findings. | journal=Clin Imaging | year= 1990 | volume= 14 | issue= 1 | pages= 23-5 | pmid=2322879 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2322879  }} </ref>
*''Empyema necessitatis'' - [[subcutaneous]] [[abscess]] resulting from the discharge of an [[empyema]] through the [[parietal pleura]]<ref name="pmid2322879">{{cite journal| author=Glicklich M, Mendelson DS, Gendal ES, Teirstein AS| title=Tuberculous empyema necessitatis. Computed tomography findings. | journal=Clin Imaging | year= 1990 | volume= 14 | issue= 1 | pages= 23-5 | pmid=2322879 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2322879  }} </ref>
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Malignancy]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Malignancy]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Rarely associated with tuberculous empyema (mean of 25 years of chronic empyema until the diagnosis of malignancy)<ref name="pmid7125345">{{cite journal| author=Roviaro GC, Sartori F, Calabrò F, Varoli F| title=The association of pleural mesothelioma and tuberculosis. | journal=Am Rev Respir Dis | year= 1982 | volume= 126 | issue= 3 | pages= 569-71 | pmid=7125345 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7125345  }} </ref><ref name="pmid2681886">{{cite journal| author=Iuchi K, Aozasa K, Yamamoto S, Mori T, Tajima K, Minato K et al.| title=Non-Hodgkin's lymphoma of the pleural cavity developing from long-standing pyothorax. Summary of clinical and pathological findings in thirty-seven cases. | journal=Jpn J Clin Oncol | year= 1989 | volume= 19 | issue= 3 | pages= 249-57 | pmid=2681886 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2681886  }} </ref><ref name="pmid1987602">{{cite journal| author=Minami M, Kawauchi N, Yoshikawa K, Itai Y, Kokubo T, Iguchi M et al.| title=Malignancy associated with chronic empyema: radiologic assessment. | journal=Radiology | year= 1991 | volume= 178 | issue= 2 | pages= 417-23 | pmid=1987602 | doi=10.1148/radiology.178.2.1987602 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1987602  }} </ref>
*Rarely associated with tuberculous [[empyema]] (average of 25 years of chronic [[empyema]] until the diagnosis of malignancy)<ref name="pmid7125345">{{cite journal| author=Roviaro GC, Sartori F, Calabrò F, Varoli F| title=The association of pleural mesothelioma and tuberculosis. | journal=Am Rev Respir Dis | year= 1982 | volume= 126 | issue= 3 | pages= 569-71 | pmid=7125345 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7125345  }} </ref><ref name="pmid2681886">{{cite journal| author=Iuchi K, Aozasa K, Yamamoto S, Mori T, Tajima K, Minato K et al.| title=Non-Hodgkin's lymphoma of the pleural cavity developing from long-standing pyothorax. Summary of clinical and pathological findings in thirty-seven cases. | journal=Jpn J Clin Oncol | year= 1989 | volume= 19 | issue= 3 | pages= 249-57 | pmid=2681886 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2681886  }} </ref><ref name="pmid1987602">{{cite journal| author=Minami M, Kawauchi N, Yoshikawa K, Itai Y, Kokubo T, Iguchi M et al.| title=Malignancy associated with chronic empyema: radiologic assessment. | journal=Radiology | year= 1991 | volume= 178 | issue= 2 | pages= 417-23 | pmid=1987602 | doi=10.1148/radiology.178.2.1987602 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1987602  }} </ref>
*Malignancy frequency according to the histopathologic diagnosis:<ref name="pmid1987602">{{cite journal| author=Minami M, Kawauchi N, Yoshikawa K, Itai Y, Kokubo T, Iguchi M et al.| title=Malignancy associated with chronic empyema: radiologic assessment. | journal=Radiology | year= 1991 | volume= 178 | issue= 2 | pages= 417-23 | pmid=1987602 | doi=10.1148/radiology.178.2.1987602 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1987602  }} </ref>
*Malignancy frequency according to the [[histopathologic]] diagnosis:<ref name="pmid1987602">{{cite journal| author=Minami M, Kawauchi N, Yoshikawa K, Itai Y, Kokubo T, Iguchi M et al.| title=Malignancy associated with chronic empyema: radiologic assessment. | journal=Radiology | year= 1991 | volume= 178 | issue= 2 | pages= 417-23 | pmid=1987602 | doi=10.1148/radiology.178.2.1987602 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1987602  }} </ref>
:*Malignant lymphoma
 
:*Squamous cell carcinoma
:*[[Malignant lymphoma]]
:*Mesothelioma
:*[[Squamous cell carcinoma]]
:*Malignant fibrous histiocytoma
:*[[Mesothelioma]]
:*Liposarcoma
:*[[Malignant fibrous histiocytoma]]
:*Rhabdomyosarcoma
:*[[Liposarcoma]]
:*Angiosarcoma
:*[[Rhabdomyosarcoma]]
:*Hemangioendothelioma
:*[[Angiosarcoma]]
:*[[Hemangioendothelioma]]
 
*Malignancy may occur due to:<ref name="pmid7125345">{{cite journal| author=Roviaro GC, Sartori F, Calabrò F, Varoli F| title=The association of pleural mesothelioma and tuberculosis. | journal=Am Rev Respir Dis | year= 1982 | volume= 126 | issue= 3 | pages= 569-71 | pmid=7125345 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7125345  }} </ref><ref name="pmid2681886">{{cite journal| author=Iuchi K, Aozasa K, Yamamoto S, Mori T, Tajima K, Minato K et al.| title=Non-Hodgkin's lymphoma of the pleural cavity developing from long-standing pyothorax. Summary of clinical and pathological findings in thirty-seven cases. | journal=Jpn J Clin Oncol | year= 1989 | volume= 19 | issue= 3 | pages= 249-57 | pmid=2681886 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2681886  }} </ref><ref name="pmid3978576">{{cite journal| author=Hillerdal G, Berg J| title=Malignant mesothelioma secondary to chronic inflammation and old scars. Two new cases and review of the literature. | journal=Cancer | year= 1985 | volume= 55 | issue= 9 | pages= 1968-72 | pmid=3978576 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3978576  }} </ref>
*Malignancy may occur due to:<ref name="pmid7125345">{{cite journal| author=Roviaro GC, Sartori F, Calabrò F, Varoli F| title=The association of pleural mesothelioma and tuberculosis. | journal=Am Rev Respir Dis | year= 1982 | volume= 126 | issue= 3 | pages= 569-71 | pmid=7125345 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7125345  }} </ref><ref name="pmid2681886">{{cite journal| author=Iuchi K, Aozasa K, Yamamoto S, Mori T, Tajima K, Minato K et al.| title=Non-Hodgkin's lymphoma of the pleural cavity developing from long-standing pyothorax. Summary of clinical and pathological findings in thirty-seven cases. | journal=Jpn J Clin Oncol | year= 1989 | volume= 19 | issue= 3 | pages= 249-57 | pmid=2681886 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2681886  }} </ref><ref name="pmid3978576">{{cite journal| author=Hillerdal G, Berg J| title=Malignant mesothelioma secondary to chronic inflammation and old scars. Two new cases and review of the literature. | journal=Cancer | year= 1985 | volume= 55 | issue= 9 | pages= 1968-72 | pmid=3978576 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3978576  }} </ref>
:*Prolonged inflammatory process in malignant lymphoma
 
:*Action of oncogenic substances in the pleura or prolonged stimulation of mesothelial cells in other types of malignancy
:*Prolonged [[inflammatory]] process in he case of [[malignant lymphoma]]
*X-ray findings include:<ref name="pmid1987602">{{cite journal| author=Minami M, Kawauchi N, Yoshikawa K, Itai Y, Kokubo T, Iguchi M et al.| title=Malignancy associated with chronic empyema: radiologic assessment. | journal=Radiology | year= 1991 | volume= 178 | issue= 2 | pages= 417-23 | pmid=1987602 | doi=10.1148/radiology.178.2.1987602 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1987602  }} </ref>
:*Action of [[oncogenic]] substances in the [[pleura]] or prolonged stimulation of mesothelial cells in other types of malignancy
 
*[[Chest X-ray]] findings include:<ref name="pmid1987602">{{cite journal| author=Minami M, Kawauchi N, Yoshikawa K, Itai Y, Kokubo T, Iguchi M et al.| title=Malignancy associated with chronic empyema: radiologic assessment. | journal=Radiology | year= 1991 | volume= 178 | issue= 2 | pages= 417-23 | pmid=1987602 | doi=10.1148/radiology.178.2.1987602 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1987602  }} </ref>
 
:*Bone destruction around the region of the [[empyema]]
:*Bone destruction around the region of the [[empyema]]
:*Increased [[thoracic cavity]] opacity
:*Increased [[thoracic cavity]] opacity
:*Medial deviation of the affected [[pleura]]
:*Medial deviation of the affected [[pleura]]
:Swelling of the soft-tissue
:Swelling of the soft-tissue
*CT scan findings may include:
 
:*Enhancement of a mass around the region of the empyema
*[[CT scan]] findings may include:
:*Attenuation of soft tissues surrounding the empyema
 
*Perform biopsy to differentiate between infection and malignancy
:*Enhancement of a mass around the region of the [[empyema]]
:*Attenuation of soft tissues surrounding the [[empyema]]
 
*Perform [[biopsy]] to differentiate between [[infection]] and [[malignancy]]
|}
|}


==Prognosis==
==Prognosis==
* If untreated, active TB is often fatal.  According to studies performed in several countries, 1/3 of the untreated patients died within 1 year after the [[diagnosis]], while > 50% died within the first 5 years.  However, with early [[diagnosis]] and adequate treatment, these patients have a good [[prognosis]].<ref name="Harrisons"></ref>
 
* [[Symptoms]] of uncomplicated TB usually improve after 2-3 weeks of treatment initiation.<ref name=PubMed>{{cite web | title = Prognosis of TB | url = http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001141/ }}</ref>
*If untreated, active TB is often fatal.  According to studies performed in several countries, 1/3 of the untreated patients died within 1 year after the [[diagnosis]], while > 50% died within the first 5 years.  However, with early [[diagnosis]] and adequate treatment, these patients have a good [[prognosis]].<ref name="Harrisons"></ref>
* Improvements in the [[chest X-ray]] require several weeks to months to be noted.<ref name=PubMed>{{cite web | title = Prognosis of TB | url = http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001141/ }}</ref>
*[[Symptoms]] of uncomplicated TB usually improve after 2-3 weeks of treatment initiation.<ref name="PubMed">{{cite web | title = Prognosis of TB | url = http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001141/ }}</ref>
*Improvements in the [[chest X-ray]] require several weeks to months to be noted.<ref name="PubMed">{{cite web | title = Prognosis of TB | url = http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001141/ }}</ref>


==References==
==References==
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{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Bacterial diseases]]
[[Category:Bacterial diseases]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Infectious disease]]
[[Category: Pulmonology]]
[[Category:Pulmonology]]
[[Category:Primary care]]

Latest revision as of 07:24, 23 March 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mashal Awais, M.D.[2]; João André Alves Silva, M.D. [3]

Overview

Tuberculosis complications are pulmonary and extra-pulmonary. Moreover, they include severe parenchymal, vascular, pleural and chest wall complications. The pulmonary complications of tuberculosis include pneumonia, pleural effusions, bronchiectasis, cavitations, and lymphadenopathy. The hematogenous spread of infection resuts in miliary tuberculosis. Without effective medical therapy, 1/3 of patients with active tuberculosis die within 1 year of diagnosis, and more than 50% die during the first 5 years. However, M. tuberculosis infections carry a good prognosis if diagnosed early and treated effectively.

Natural History

Without proper medical therapy, 1/3 of patients with active tuberculosis die within 1 year of the diagnosis, and more than 50% during the first 5 years. The 5-year mortality rate in patients with a positive sputum smear test for M. tuberculosis is 65%. Patients who survive the 5 years have probability of 60% of spontaneous remission. [1]

Primary Pulmonary Tuberculosis

Primary tuberculosis occurs soon after infection with M. tuberculosis and differs from clinical illness. In endemic areas, primary TB is usually observed at a young age. Primary TB may be completely asymptomatic, or iinvolves mild symptoms, such as fever, cough, and chest pain, due to pleurisy. Some patients can have other symptoms, such as erythema nodosum in the lower limbs and phlyctenulosis. The initial lesion (Ghon focus) often resolves spontaneously, becoming a calcified nodule that may be identified on the chest X-Ray. Pleuritic chest pain usually occurs as a result of the pleural reaction to the underlying Ghon focus.[1]

The progression of primary TB is more rapidly in patients with impaired immunity and in children. Progression of primary tuberculosis results in the enlargement of the Ghon focus. The disease may have the following manifestations:[1]

Primary infection leads to dissemination of M. tuberculosis through the blood. With impaired immune response, miliary tuberculosis may occur resulting in the formation of granulomatous lesions in several organs.[1]

Chest X-Ray of patient with Miliary TuberculosisImage from Wikimedia Commons[2]

Secondary Pulmonary Tuberculosis

Also known as "adult-type" or "post-primary tuberculosis". May result from recent infection with M. tuberculosis, or from the reactivation of an endogenous focus containing the latent form of the infection. Without effective medical therapy, approximately 1/3 of patients die within months of disease onset. Of the remaining 2/3, some can develop spontaneous remission, while others experience a chronic infection with severe symptoms. The survivors may have fibrotic and calcified lesions, and cavitations in some areas of the lungs, that can be detected later on a chest X-Ray.[1]

The onset of illness is insidious and nonspecific, and the symptoms include:

Complications

Tuberculosis may be localized to the lungs, or affects other organs of the body. Pulmonary TB can result in permanent damage of the lungs and affected organs. According to the pulmonary, or extrapulmonary nature of the lesions, the possible complications may include:[3][4]

Parenchymal Lesions
Complication Description
Tuberculoma
Cicatrization
  • Common in secondary TB
  • Marked fibrosis in ≤40% of secondary TB cases, which may present as:
  • Unspecific X-Ray findings may include:[3]
  • Parenchymal bands
  • Fibrotic cavities
  • Fibrotic nodules
  • Traction bronchiectasis
Thin-walled cavity
  • Found in both the active and inactive forms of the disease
  • May regress with treatment
  • Air-filled cysts may persist[8]
  • Maybe misidentified as an emphysematous bulla or pneumatocele.
Aspergilloma
  • Mass of hyphae, cell debris and mucus, usually present in a cavity or bronchus[9][10][11]
  • Previous history of chronic cavitary TB in 25-55% of cases presenting with aspergilloma
  • Often occurs with hemoptysis in 50-90% of the cases
  • X-ray reveals a mobile mass ringed by an air shadow
  • CT reveals a mobile mass, generally interspaced with air shadows
  • Maybe calcified
Lung destruction[3]
Bronchogenic carcinoma[3]
  • Maybe misinterpreted as TB progression
  • Scar formation in TB may lead to carcinoma
  • May cause reactivation of TB[12][13]

Airway Lesions
Complication Description
Bronchiectasis
  • It occurs due to the bronchial wall involvement, with fibrosis, and secondary bronchial dilation, often called traction bronchiectasis
  • Identified on CT in 30-60% of cases of secondary TB, and in 71-86% of cases of inactive TB[14][15]
  • Indicative of TB when located at the apical-posterior segment of the lung
Tracheobronchial stenosis
  • Predominance on the left main bronchus
  • Caused by:
  • Granulomatous tracheobronchial wall changes
  • Enlargement of peribronchial lymph nodes pressing on the tracheobronchial wall
  • Endobronchial involvement in 2-4% of the cases
  • Tracheobronchial narrowing from the formation of intraluminal granulation tissue
  • CT scan findings may include:
Broncholithiasis

Vascular Lesions
Complication Description
Pulmonary or bronchial arteritis and thrombosis
Bronchial artery dilatation
Rasmussen's aneurysm
  • Results from the replacement of normal media and adventitia by granulation tissue that weakens the arterial wall
  • Commonly presents with hemoptysis
  • Life-threatening when massive hemoptysis occurs

Mediastinal Lesions
Complication Description
Esophagobronchial fistula
Esophagomediastinal fistula
  • Common involvement of the subcarinal region
Constrictive pericarditis
  • Complicates 1% of TB cases[25]
  • Frequently caused by extension of tuberculous lymphadenitis
  • May occur in miliary TB[6]
  • Common findings on CT may include:
Lymph node calcification
Fibrosing mediastinitis
  • Rare[30]
  • May present with mild symptoms, such as:
  • CT findings may include:
  • May cause bronchial obstruction, and consequently:[30][31]
Extranodal extension
  • Commonly affects the following structures:

Pleural Lesions
Complication Description
Bronchopleural fistula
  • May occur:
  • Spontaneously
  • After trauma
  • After surgery
  • Diagnostic findings include:
  • Increased sputum production
  • Changes in the air-fluid level
  • Air trapping in the pleural space
  • Spread of pneumonic infiltration to the contralateral lung
Fibrothorax and chronic empyema
  • Pleural infection may occur following:[33][34]
  • Rupture of a subpleural focus of infection
  • Lymph node infection caused by hematogenous dissemination
  • Pleural thickening
  • Calcification
Pneumothorax
  • Occurs in about 5% of patients with secondary TB
  • Rare in miliary TB
  • Present in severe stages of tuberculous lung disease
  • Commonly follows empyema and bronchopleural fistula
  • Consider active TB if, after reexpansion, apical changes are noted

Chest Wall Lesions
Complication Description
Tuberculous spondylitis (Pott's disease)
  • Hematogenous spread of pulmonary TB
  • Commonly affected areas include:
  • X-ray findings in the early stage of the disease may include:
  • Vertebral endplate irregularities
  • Reduction of the intervertebral disk space
  • Adjacent bone sclerosis
  • Paravertebral abscess
  • Peripheral rim enhancement
  • Area of low-attenuation at the center of the abscess, after enhancement
Rib tuberculosis
  • Characterized by:
Malignancy
Swelling of the soft-tissue
  • Enhancement of a mass around the region of the empyema
  • Attenuation of soft tissues surrounding the empyema

Prognosis

  • If untreated, active TB is often fatal. According to studies performed in several countries, 1/3 of the untreated patients died within 1 year after the diagnosis, while > 50% died within the first 5 years. However, with early diagnosis and adequate treatment, these patients have a good prognosis.[1]
  • Symptoms of uncomplicated TB usually improve after 2-3 weeks of treatment initiation.[4]
  • Improvements in the chest X-ray require several weeks to months to be noted.[4]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
  2. ↑ "Wikimedia Commons".
  3. ↑ 3.0 3.1 3.2 3.3 Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH (2001). "Thoracic sequelae and complications of tuberculosis". Radiographics. 21 (4): 839–58, discussion 859-60. doi:10.1148/radiographics.21.4.g01jl06839. PMID 11452057.
  4. ↑ 4.0 4.1 4.2 "Prognosis of TB".
  5. ↑ 5.0 5.1 Woodring JH, Vandiviere HM, Fried AM, Dillon ML, Williams TD, Melvin IG (1986). "Update: the radiographic features of pulmonary tuberculosis". AJR Am J Roentgenol. 146 (3): 497–506. doi:10.2214/ajr.146.3.497. PMID 3484866.
  6. ↑ 6.0 6.1 6.2 6.3 Lee KS, Song KS, Lim TH, Kim PN, Kim IY, Lee BH (1993). "Adult-onset pulmonary tuberculosis: findings on chest radiographs and CT scans". AJR Am J Roentgenol. 160 (4): 753–8. doi:10.2214/ajr.160.4.8456658. PMID 8456658.
  7. ↑ Palmer PE (1979). "Pulmonary tuberculosis--usual and unusual radiographic presentations". Semin Roentgenol. 14 (3): 204–43. PMID 472765.
  8. ↑ Fraser, Richard (1994). Synopsis of diseases of the chest. Philadelphia: W.B. Saunders. ISBN 0721636691.
  9. ↑ Logan PM, Müller NL (1996). "CT manifestations of pulmonary aspergillosis". Crit Rev Diagn Imaging. 37 (1): 1–37. PMID 8744521.
  10. ↑ Miller WT (1996). "Aspergillosis: a disease with many faces". Semin Roentgenol. 31 (1): 52–66. PMID 8838945.
  11. ↑ Thompson BH, Stanford W, Galvin JR, Kurihara Y (1995). "Varied radiologic appearances of pulmonary aspergillosis". Radiographics. 15 (6): 1273–84. doi:10.1148/radiographics.15.6.8577955. PMID 8577955.
  12. ↑ Snider GL, Placik B (1969). "The relationship between pulmonary tuberculosis and bronchogenic carcinoma. A topographic study". Am Rev Respir Dis. 99 (2): 229–36. PMID 4975011.
  13. ↑ Ting YM, Church WR, Ravikrishnan KP (1976). "Lung carcinoma superimposed on pulmonary tuberculosis". Radiology. 119 (2): 307–12. doi:10.1148/119.2.307. PMID 1265261.
  14. ↑ Lee KS, Hwang JW, Chung MP, Kim H, Kwon OJ (1996). "Utility of CT in the evaluation of pulmonary tuberculosis in patients without AIDS". Chest. 110 (4): 977–84. PMID 8874255.
  15. ↑ Hatipoğlu ON, Osma E, Manisali M, Uçan ES, Balci P, Akkoçlu A; et al. (1996). "High resolution computed tomographic findings in pulmonary tuberculosis". Thorax. 51 (4): 397–402. PMC 1090675. PMID 8733492.
  16. ↑ 16.0 16.1 Galdermans D, Verhaert J, Van Meerbeeck J, de Backer W, Vermeire P (1990). "Broncholithiasis: present clinical spectrum". Respir Med. 84 (2): 155–6. PMID 2371439.
  17. ↑ 17.0 17.1 Kowal LE, Goodman LR, Zarro VJ, Haskin ME (1983). "CT diagnosis of broncholithiasis". J Comput Assist Tomogr. 7 (2): 321–3. PMID 6833568.
  18. ↑ 18.0 18.1 Conces DJ, Tarver RD, Vix VA (1991). "Broncholithiasis: CT features in 15 patients". AJR Am J Roentgenol. 157 (2): 249–53. doi:10.2214/ajr.157.2.1853800. PMID 1853800.
  19. ↑ Fraser, Richard (1994). Synopsis of diseases of the chest. Philadelphia: W.B. Saunders. ISBN 0721636691.
  20. ↑ 20.0 20.1 Song JW, Im JG, Shim YS, Park JH, Yeon KM, Han MC (1998). "Hypertrophied bronchial artery at thin-section CT in patients with bronchiectasis: correlation with CT angiographic findings". Radiology. 208 (1): 187–91. doi:10.1148/radiology.208.1.9646812. PMID 9646812.
  21. ↑ Ramakantan R, Bandekar VG, Gandhi MS, Aulakh BG, Deshmukh HL (1996). "Massive hemoptysis due to pulmonary tuberculosis: control with bronchial artery embolization". Radiology. 200 (3): 691–4. doi:10.1148/radiology.200.3.8756916. PMID 8756916.
  22. ↑ 22.0 22.1 Im JG, Kim JH, Han MC, Kim CW (1990). "Computed tomography of esophagomediastinal fistula in tuberculous mediastinal lymphadenitis". J Comput Assist Tomogr. 14 (1): 89–92. PMID 2299003.
  23. ↑ Fraser, Richard (1994). Synopsis of diseases of the chest. Philadelphia: W.B. Saunders. ISBN 0721636691.
  24. ↑ Mönig SP, Schmidt R, Wolters U, Krug B (1995). "Esophageal tuberculosis: a differential diagnostic challenge". Am J Gastroenterol. 90 (1): 153–4. PMID 7801924.
  25. ↑ Larrieu AJ, Tyers GF, Williams EH, Derrick JR (1980). "Recent experience with tuberculous pericarditis". Ann Thorac Surg. 29 (5): 464–8. PMID 7377888.
  26. ↑ Agrons GA, Markowitz RI, Kramer SS (1993). "Pulmonary tuberculosis in children". Semin Roentgenol. 28 (2): 158–72. PMID 8516692.
  27. ↑ Leung AN, Müller NL, Pineda PR, FitzGerald JM (1992). "Primary tuberculosis in childhood: radiographic manifestations". Radiology. 182 (1): 87–91. doi:10.1148/radiology.182.1.1727316. PMID 1727316.
  28. ↑ Choyke PL, Sostman HD, Curtis AM, Ravin CE, Chen JT, Godwin JD; et al. (1983). "Adult-onset pulmonary tuberculosis". Radiology. 148 (2): 357–62. doi:10.1148/radiology.148.2.6867325. PMID 6867325.
  29. ↑ Hopewell PC (1995). "A clinical view of tuberculosis". Radiol Clin North Am. 33 (4): 641–53. PMID 7610236.
  30. ↑ 30.0 30.1 30.2 Atasoy C, Fitoz S, Erguvan B, Akyar S (2001). "Tuberculous fibrosing mediastinitis: CT and MRI findings". J Thorac Imaging. 16 (3): 191–3. PMID 11428422.
  31. ↑ 31.0 31.1 Kushihashi T, Munechika H, Motoya H, Hamada K, Satoh I, Naitoh H; et al. (1995). "CT and MR findings in tuberculous mediastinitis". J Comput Assist Tomogr. 19 (3): 379–82. PMID 7790546.
  32. ↑ Johnson TM, McCann W, Davey WN (1973). "Tuberculous bronchopleural fistula". Am Rev Respir Dis. 107 (1): 30–41. PMID 4683320.
  33. ↑ Hulnick DH, Naidich DP, McCauley DI (1983). "Pleural tuberculosis evaluated by computed tomography". Radiology. 149 (3): 759–65. doi:10.1148/radiology.149.3.6647852. PMID 6647852.
  34. ↑ Müller NL (1993). "Imaging of the pleura". Radiology. 186 (2): 297–309. doi:10.1148/radiology.186.2.8421723. PMID 8421723.
  35. ↑ Schmitt WG, Hübener KH, Rücker HC (1983). "Pleural calcification with persistent effusion". Radiology. 149 (3): 633–8. doi:10.1148/radiology.149.3.6647839. PMID 6647839.
  36. ↑ Kuhlman JE, Singha NK (1997). "Complex disease of the pleural space: radiographic and CT evaluation". Radiographics. 17 (1): 63–79. doi:10.1148/radiographics.17.1.9017800. PMID 9017800.
  37. ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID http://dx.doi.org/10.1148/radiology.175.1.2315473 Check |pmid= value (help).
  38. ↑ Im JG, Chung JW, Han MC (1993). "Milk of calcium pleural collections: CT findings". J Comput Assist Tomogr. 17 (4): 613–6. PMID 8331232.
  39. ↑ Song JW, Im JG, Goo JM, Kim HY, Song CS, Lee JS (2000). "Pseudochylous pleural effusion with fat-fluid levels: report of six cases". Radiology. 216 (2): 478–80. doi:10.1148/radiology.216.2.r00jl09478. PMID 10924573.
  40. ↑ Ridley N, Shaikh MI, Remedios D, Mitchell R (1998). "Radiology of skeletal tuberculosis". Orthopedics. 21 (11): 1213–20. PMID 9845453.
  41. ↑ Sharif HS, Morgan JL, al Shahed MS, al Thagafi MY (1995). "Role of CT and MR imaging in the management of tuberculous spondylitis". Radiol Clin North Am. 33 (4): 787–804. PMID 7610245.
  42. ↑ 42.0 42.1 Lee G, Im JG, Kim JS, Kang HS, Han MC (1993). "Tuberculosis of the ribs: CT appearance". J Comput Assist Tomogr. 17 (3): 363–6. PMID 8491894.
  43. ↑ 43.0 43.1 Adler BD, Padley SP, Müller NL (1993). "Tuberculosis of the chest wall: CT findings". J Comput Assist Tomogr. 17 (2): 271–3. PMID 8454753.
  44. ↑ Glicklich M, Mendelson DS, Gendal ES, Teirstein AS (1990). "Tuberculous empyema necessitatis. Computed tomography findings". Clin Imaging. 14 (1): 23–5. PMID 2322879.
  45. ↑ 45.0 45.1 Roviaro GC, Sartori F, Calabrò F, Varoli F (1982). "The association of pleural mesothelioma and tuberculosis". Am Rev Respir Dis. 126 (3): 569–71. PMID 7125345.
  46. ↑ 46.0 46.1 Iuchi K, Aozasa K, Yamamoto S, Mori T, Tajima K, Minato K; et al. (1989). "Non-Hodgkin's lymphoma of the pleural cavity developing from long-standing pyothorax. Summary of clinical and pathological findings in thirty-seven cases". Jpn J Clin Oncol. 19 (3): 249–57. PMID 2681886.
  47. ↑ 47.0 47.1 47.2 Minami M, Kawauchi N, Yoshikawa K, Itai Y, Kokubo T, Iguchi M; et al. (1991). "Malignancy associated with chronic empyema: radiologic assessment". Radiology. 178 (2): 417–23. doi:10.1148/radiology.178.2.1987602. PMID 1987602.
  48. ↑ Hillerdal G, Berg J (1985). "Malignant mesothelioma secondary to chronic inflammation and old scars. Two new cases and review of the literature". Cancer. 55 (9): 1968–72. PMID 3978576.

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