Radiology 1993

Professor Harumi Itoh Professor Jung-Gi Im

 Pathogenesis

1 2 3 4
Im Jg, Itoh H, et al. Radiology 1993; 186: 653-660
 1

JB West. et al. Pulmonary Physiology and Pathophysiology 2th ed. Philadelphia: Lippincott Williams & Wilkins; 2007
Tree-in-bud pattern
Tuberculosis Bronchopneumonia
Courtesy from Prof. Harumi Itoh
Tuberculosis Pneumonia
2
3
Tuberculosis Lung cancer
4
Courtesy from Prof. Jung-Gi Im
Tuberculosis with 5-mo follow up

13-02-2561 25-07-2561
Inspiration Expiration
Inspiration Expiration
Inspiration Expiration
Location and Multi-stage
 Chronic lung disease
• Asthma
• COPD
• Bronchiectasis
• ILD
• Post tuberculosis lung disease (PTLD)
 Post Tuberculosis lung Disease (PTLD)
• More than 10 millions in 2020.
• 3-6 times higher rate of mortality from
cardiovascular* and respiratory diseases.**
• Ongoing symptoms after treatment:
Breathlessness, cough.***
• Ongoing inflammation and fibrosis after
treatment is not clear.
*Romanowski K, et al. Lancet Infect Dis. 2019 ; 19(10): 1129–37.
**Ranzani OT, et al. Lancet Infect Dis. 2020 ; 20(1): 123–32.
***Banu Rekha VV, et al. Indian J Tuberc. 2009; 56(3): 132–40./ Ehrlich RI, et
al. Int J Tuberc Lung Dis. 2004; 8(3): 369–76.
 Mile stones
• First half of 20th century = Complication
• Second half = Diagnosis and treatment
• 21th century = Long term sequelae and
impacts for family and communities

Allwood BW, et al. Respiration 2021;100:751–763

 Post Tuberculosis lung Disease
(PTLD)
• Large airway
Cough, Wheez, Hemoptysis
• Small airway
• Lung parenchyma Dyspnea
• Vasculature
• Pleura
 Post Tuberculosis lung Disease (PTLD)

• Large airway = HRCT.

• 170/445 (44.2%) post-treatment showed
bronchiectasis, 12.7% were severe.*

*Meghji J, et al. Thorax 2020; 75: 269–78.

 Small airway and Interstitium in PTLD
• Residual spirometric abnormalities*, Hemoptysis
• Obstructive 18.4-86%
• Restrictive 16.1-63.3%
• Reduced lung volume (Plethysmography)?
• DLCO?
• Imaging?
*Munoz-Torrico M, et al. J Bras Pneumol. 2016 ; 42(5): 374–85.
**Ravimohan S, et al. Eur Respir Rev. 2018; 27(147): 170077.
Meghji J, et al. Thorax.2020; 75(3): 269–78.
Khosa C, et al. BMC Pulm Med. 2020; 20(1): 127.
Chesov D, et al. Int J Tuberc Lung Dis 2021; 25: 277–284.
 Lung parenchyma in PTLD
• Parenchyma = Consolidation, nodules
• 5/445 (1.3%) mycetoma*
• The most common risk factor for chronic
pulmonary aspergillosis, 18% 5Y prevalence
rate**
• Relapse and recurrence***because poor
immune in destroyed lung
*Meghji J, et al. Thorax 2020; 75: 269–78.
**Denning DW, etal. Bull World Health Organ. 2011; 89: 864–72.
***Marx FM, et al. Eur Respir J. 2016; 48: 1227–30
 Post Tuberculosis lung Disease (PTLD)

• Vascular = Unknown
• Secondary to parenchymal destruction

*Meghji J, et al. Thorax 2020; 75: 269–78.

**Denning DW, etal. Bull World Health Organ. 2011; 89: 864–72.
 Conclusion
• Tuberculosis is common
• Characteristic in both appearances/ location
• Role of CT (especially low-dose HRCT)
• Post tuberculosis lung disease (PTLD)