Radiology in Pulmonary Tuberculosis
Pp. 49-64 (16)
Almerio S. Machado and Paulo R.Z. Antas
Pulmonary tuberculosis is a common worldwide infection, causing high mortality and
morbidity, especially in developing countries. Despite advances in diagnosis of tuberculosis, chest
imaging, combined with the clinical history, remain the basis in the diagnosis, staging and follow-up of
pulmonary tuberculosis. Typical radiological patterns of pulmonary tuberculosis help clinicians in
management of the disease. Upper zone shadows, frequently bilateral and often associated with
cavitation, are typical, as are miliary lesions. However, these findings are uncommon in childhood
thoracic tuberculosis. The diagnosis of childhood intrathoracic tuberculosis depends on a constellation
of symptoms, signs, and tuberculin skin test and chest radiograph results. Paratracheal, mediastinal, and
hilar lymphadenopathy are frequent in childhood tuberculosis. In HIV-infected patients the radiological
appearances are less specific, just as symptoms and signs may not be typical and sputum is often
negative on direct smear. However chest computed tomography (CT) is frequently necessary to
establish the need of additional tests. CT is more sensitive than chest X-ray in the detection and
characterization of both slight localized or disseminated parenchymal disease and mediastinal
lymphadenopathy. Eventually, nuclear medicine can be necessary since it provides tools for diagnosis
and monitoring tuberculosis mainly in children, HIV immunecompromised individuals, tuberculosis
sequel and suspected reactivation.
Childhood Intrathoracic Tuberculosis, Radiological Diagnosis, Cavitation, Chest Computer
Tomography, Nuclear Medicine.
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