Pulmonary tuberculosis

(p72-75)
• Primary tuberculosis

• Postprimary tuberculosis
• Primary tuberculosis :

usually occurs in childhood.

• In primary tuberculosis an area of
consolidation , develops in the periphery
of the lung usually in the mid or upper
zones.
• Usually, the pulmonary shadow is small
•
• but it may occasionally involve most the
lobe.
• Sometimes the pulmonary consolidation
is often accompanied by visibly enlarged
hilar or mediastinum lymph nodes
(Fig.2.80a).
 So, This combination of pulmonary
consolidation and lymphadenopathy is
known as the primary complex.
The clinical features of the primary complex
vary.
 The majority of patients have few
symptoms and the disease is usually not
recognized.
They remaind have fever, cough and
malaise.
• In most cases, whether treated or not,
the primary complex heals and often
calcifies.
• A calcified primary complex often
remains visible throughout life.
 Spread of infection.
Spread of infection may occur:
1.via the bronchial tree, which appears
radiologically as patchy lobar
consolidation; it often involves more than
one lob may be bilateral and frequently
cavitates;
2.via the blood stream, resulting in miliary
tuberculosis (Fig.2.80b) ,(p72).
Postprimary tuberculosis:
(p72)
Postprimary tuberculosis:
usually presents with cough,
haemoptysis( 咯血 )
, weight loss, night sweats or malaise.
1. The disease may be discovered on a
routine chest film;
2.Postprimary tuberculosis is usually
confined to the upper posterior portions of
the chest, namely the apical and posterior
segments of the upper lobes ,and the apical
segments of the lower lobes.
The initial lesions are:
1. multiple small areas of
consolidation (Fig. 2.81a) :
2.maybe bilateral.
• If the infection progresses the
consolidations enlarge and
frequently cavitate, Cavity could
been seen as rounded pulmonary
shadowing (Fig.2.81b).
• If the diagnosis of cavitation are
difficult , we may use tomography
or CT.
The infection may undergo partial
or complete healing at any stage.
Healing occurs by fibrosis, often with
calcification (Fig.2.82)
but both fibrosis and calcification
may be seen in the presence of
continuing activity .
• Chronic fibrous cavitary
tuberculosis
Pleural effusions are frequent,
they often leave permanent( 永久的 )
pleural thickening which may
calcify.
• Tuberculoma.
• The term tuberculoma refers to a tuberculous
granuloma in the form of a spherical mass,
usually less than 3cm in diameter.
• The edge is usually sharply defined and these
lesions are often partly calcified.
• Conventional or computed tomography may be
needed to demonstrate the calcification.
• Most tuberculomas are inactive, but viable
tubercle bacilli （杆菌） may be present even in
the calcified lesions.
• Smooth border
• Calcification in the spherical
lesion
• Satellite lesion
Is the disease active?
An important role for radiology in patients
with pulmonary tuberculosis is to try and
determine whether the disease is active or
inactive.
This can be very difficult and is sometimes
impossible.
Valuable diagnostic signs of activity
are:
1.development of new lesions on
serial films;
2.demonstration of cavities.(p75)