Journal of Pulmonary & Respiratory

Medicine

Disusun oleh:
Cut Annisa Widari
Pembimbing:
dr. Anna Deliana, Sp.P
 Introduction
With an estimated 9 million new cases and about 1.5
million associated deaths annually, active tuberculosis
(TB) continues to be a major cause of morbidity and
mortality worldwide.

In 2010, China had an estimated 1 million new

tuberculosis cases, accounting for 11% of global
tuberculosis incidence.
 Recently, an outbreak of tuberculosis in school was pay
attention by the local government. Although the chest X-
ray and purified protein derivative (PPD) is a common
method for the screening of tuberculosis in schools, some
studies have shown that using the direct digital radiography
(DR) to detect the small lesions is limited, which might
lead to the misdiagnosis.

This study was conducted in an outbreak of tuberculosis in

a middle school in China, by contrast with CT, to evaluate
the clinical value and limitation of chest DR in screening
the close contacts.
 Materials and method
All the contacts were taken the postero-
anterior chest DR, by using the Philips
DIGITAL DIAGOSIS digital camera.

CT examinations were carried out by using

GE-lightspeed 16 multislice spiral CT scanner
with scanning range from the thoracic inlet to
the bottom level of the chest,
 methods
Clinical Trial (Experimental)
Two experienced senior radiologists
were employed to analysis images of
the chest DR and CT of the 35
contact students by using double
blind method.
A third doctor was employed to
statistic the misdiagnosis rate of DR.
 Statistical analysis
Statistical analyses were performed
using SPSS 17.0 for Windows OS.
Count data was described by rate or
constituent ratio, and compared
using chi square test, and P < 0.05
was considered as statistically
significant.
 Material and methods
A total of 35 patients examined both
with chest DR and CT were included
in this study, including 18 male and
17 female, aged from 15 to 17 with
the average age of about 15 years.

18 17
 8 cases
detected

27 cases
Digital Radiography undetecte
(DR) / Chest X-Ray d

Result:

8 cases were diagnosed as tuberculosis by using DR

screening and clinical examination, including 4 cases of
pulmonary tuberculosis, 2 cases of pulmonary tuberculosis
complicated with pleurisy and 2 cases of tuberculous pleurisy.
 14
cases
detect
CT (Computed ed
Tomography)

14 were detected:

8 cases which were detected by chest DR,

Additional 6 cases detected by CT which were
missed by DR.
 8 cases which
were detected Sputum smear, culture and
by chest DR Gene Xpert

among which it showed that all were negative of sputum

smear,
1 case was positive for sputum culture,
and 3 cases were positive for Xpert Gene.
All the 8 cases were given the combined treatment of
2HRZE/4HR.
 6 additional
cases that Sputum smear, culture and
detected by CT Gene Xpert

Additional 6 cases detected by CT which were missed by

DR, didn't have obvious clinical symptoms, while sputum
smear, sputum culture and Xpert Gene detection were all
negative.

Via the clinical consultation, they were finally considered as

tuberculosis infection, and were given the combined
treatment of 2HRZE/4HR. All patients were follow-up by CT
scanning.
 Fig. 1. A,B: Female, 16 years old, the close contactor.
(A) Chest X-ray film showed no abnormal shadows in
the lung field.
(B) CT scan of the Chest showed patchy ground-glass
opacity (GGO) located in the area between azygos vein
and esophagus.
 Fig. 2. A,B: Female, 15 years old, the close
contactor.
(A) Chest X-ray film showed no abnormal shadows
in the lung field.
(B) CT scan of the Chest showed small nodules
and tree-in-bud in the left lower lobe.
 Result and discussion
Follow-up of misdiagnosis cases by chest
DR

Follow-up by CT at the end of 2HREZ/4HR

experimental therapy, 2 cases were
significantly absorbed after 2 months' anti-TB
treatment;
and the others were significantly absorbed
after 4 months consolidation anti-TB
treatment.
 Chest DR played an important role in the diagnosis
of active tuberculosis, while the sensitivity and
specificity were only 81.6% and 67.0% respectively .

Considering the advantages of multi-slice CT

technology, such as high spatial resolution and non-
overlap in the chest images,
CT is significantly better than DR in detecting the
internal structure, the hidden parts, small lesions,
lymph nodes and aspects of small cavities.
The CT signs of tree-in-bud, centri-lobular nodule,
vague nodules, ground-glass opacity and others
were helpful in early detection active tuberculosis
 discussion
Compared with CT, there were 6
cases missed by using chest DR
42.9% (6/14), due to anatomical
conceal sites, such as local area
between azygos vein and esophagus
(Fig. 1), thickening of the blood
vessels in the lower lobe and the
diaphragmatic occlusion (Fig. 2), or
due to other reason.
 In conclusion,
in the investigation of close contacts during
TB outbreak, chest DR had the advantages
of low price, convenience and small
radiation, but larger misdiagnosis rate
which affect accurately judgment and
effective clinical treatment. While, CT
especially low-dose multi-slice spiral CT was
superior for non-overlapping images and
high resolution density which will make it an
increasingly important clinical role in close
contacts investigation in tuberculosis
outbreak.
 Thank you