Tuberculosis natural history, complications and prognosis: Difference between revisions

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__NOTOC__
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{{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>


Disease onset is insidious and unspecific, presenting with [[symptoms]] that may include:
The onset of illness is insidious and nonspecific, and the [[symptoms]] include:
* [[Fever]]
 
* [[Night sweats]]
*[[Fever]]
* [[Weakness]]
*[[Night sweats]]
* [[Malaise]]
*[[Weakness]]
* [[Anorexia]]
*[[Malaise]]
* [[Weight loss]]
*[[Anorexia]]
* [[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
*[[Weight loss]]
* [[Hemoptysis]] (20-30% cases) may occur in the following cases:
*[[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
:*Rupture of a [[blood vessel]] on a cavity wall (severe [[hemoptysis]])
*[[Hemoptysis]] (20-30% cases) may occur in the following cases:
 
:*Rupture of a [[blood vessel]] on a cavity wall leads to 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.  Depending on the pulmonary, or extrapulmonary nature of the lesion, 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>
[[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
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|+
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! 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}}
|-
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| 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 Chest X-ray in 5% 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>
* Results from the surrounding of M. tuberculosis with inflammatory or connective tissue.<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 (80%)
*Satellite lesions in 80% of the cases
* Nodular or diffused calcifications in 20-30% 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 love 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:<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
:*Fibrotic nodules
:*Fibrotic nodules
:*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 disease
*Found in both the active and inactive forms of the disease
* May regress after treatment
*May regress with treatment
* Air-filled sect 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 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 courses with [[hemoptysis]] (50-90%)
*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>
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Common in end-stage of TB
*Common in later stages of TB
*Involvement of the airways and parenchyma
*Involvement of the [[airways]] and [[parenchyma]]
*May follow primary TB or secondary TB
*May follow primary TB or secondary TB
*Spreads across the lung with cavitation and fibrosis<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>
*Spreads across the lung with [[cavitation]] and [[fibrosis]]<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>
*Concomitant infection with bacteria or bacteria may occur
*Concomitant [[infection]] with [[bacteria]] or fungi may occur
*Complicates assessment of TB activity in the lung with the 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 111: 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 of 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 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 (2-4% cases)
 
*Tracheobronchial narrowing from intraluminal granulation tissue
*Endobronchial involvement in 2-4% of the cases
*On CT scan appears as:
*Tracheobronchial narrowing from the formation of intraluminal granulation tissue
*[[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;" |
*Calcified material within the tracheobronchial lumen, with origin 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>
*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>
*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 X-ray, common finding include:
*On the [[chest X-ray]], common findings may include:
:*Change in position of the calcified material
 
:*Airway obstruction
:*[[Airway]] obstruction
:*Atelectasis
:*[[Atelectasis]]
:*Air trapping on expiration
:*[[Air trapping]] on the expiration
:*Frequent change in position of the calcified material
:*Mucoid impaction
:*Mucoid impaction
*Common findings on CT 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]]
*[[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
:*[[Atelectasis]]
:*[[Atelectasis]]
:*Obstructive [[pneumonitis]]
:*Obstructive [[pneumonitis]]
Line 155: 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>
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Bronchial artery]] dilatation
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Bronchial artery]] dilatation
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Common in parenchymal tuberculosis or TB complicated by bronchiectasis<ref name="pmid9646812">{{cite journal| author=Song JW, Im JG, Shim YS, Park JH, Yeon KM, Han MC| title=Hypertrophied bronchial artery at thin-section CT in patients with bronchiectasis: correlation with CT angiographic findings. | journal=Radiology | year= 1998 | volume= 208 | issue= 1 | pages= 187-91 | pmid=9646812 | doi=10.1148/radiology.208.1.9646812 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9646812  }} </ref><ref name="pmid8756916">{{cite journal| author=Ramakantan R, Bandekar VG, Gandhi MS, Aulakh BG, Deshmukh HL| title=Massive hemoptysis due to pulmonary tuberculosis: control with bronchial artery embolization. | journal=Radiology | year= 1996 | volume= 200 | issue= 3 | pages= 691-4 | pmid=8756916 | doi=10.1148/radiology.200.3.8756916 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8756916  }} </ref>
*Common in [[parenchymal]] TB or TB complicated by [[bronchiectasis]]<ref name="pmid9646812">{{cite journal| author=Song JW, Im JG, Shim YS, Park JH, Yeon KM, Han MC| title=Hypertrophied bronchial artery at thin-section CT in patients with bronchiectasis: correlation with CT angiographic findings. | journal=Radiology | year= 1998 | volume= 208 | issue= 1 | pages= 187-91 | pmid=9646812 | doi=10.1148/radiology.208.1.9646812 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9646812  }} </ref><ref name="pmid8756916">{{cite journal| author=Ramakantan R, Bandekar VG, Gandhi MS, Aulakh BG, Deshmukh HL| title=Massive hemoptysis due to pulmonary tuberculosis: control with bronchial artery embolization. | journal=Radiology | year= 1996 | volume= 200 | issue= 3 | pages= 691-4 | pmid=8756916 | doi=10.1148/radiology.200.3.8756916 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8756916  }} </ref>
*[[CT]] is the imaging test of choice, allowing identification of dilated bronchial arteries, therefore avoiding biopsy of an hypertrophied bronchial artery instead of a lymph node.<ref name="pmid9646812">{{cite journal| author=Song JW, Im JG, Shim YS, Park JH, Yeon KM, Han MC| title=Hypertrophied bronchial artery at thin-section CT in patients with bronchiectasis: correlation with CT angiographic findings. | journal=Radiology | year= 1998 | volume= 208 | issue= 1 | pages= 187-91 | pmid=9646812 | doi=10.1148/radiology.208.1.9646812 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9646812  }} </ref>
*[[CT]] is the imaging test of choice for diagnosis, allowing identification of dilated [[bronchial arteries]]. It avoids wrongful [[biopsy]] of an hypertrophied [[bronchial artery]], instead of a [[lymph node]].<ref name="pmid9646812">{{cite journal| author=Song JW, Im JG, Shim YS, Park JH, Yeon KM, Han MC| title=Hypertrophied bronchial artery at thin-section CT in patients with bronchiectasis: correlation with CT angiographic findings. | journal=Radiology | year= 1998 | volume= 208 | issue= 1 | pages= 187-91 | pmid=9646812 | doi=10.1148/radiology.208.1.9646812 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9646812  }} </ref>
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Rasmussen's aneurysm]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Rasmussen's aneurysm]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Results from the replacement of normal media and [[adventitia]] by granulation tissue that weakens [[arterial wall]]
*Results from the replacement of normal media and [[adventitia]] by granulation tissue that weakens the [[arterial]] wall
 
*Commonly presents with [[hemoptysis]]
*Commonly presents with [[hemoptysis]]
*Life-threatening when massive [[hemoptysis]] occurs
*Life-threatening when massive [[hemoptysis]] occurs
|}
|}


===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]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Occurs when an infected [[lymph node]] erodes the [[bronchial]] wall<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>
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Esophagomediastinal [[fistula]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Esophagomediastinal [[fistula]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Rare
*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>
:*[[Strictures]]
:*[[Mediastinal]] or [[tracheobronchial]] fistulas
:*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>
:*[[Fever]]
:*[[Cough]]
:*[[Weight loss]]
:*[[Dysphagia]]
:*[[Chest discomfort]]
:*[[Back pain]]
*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]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Complicates 1% of TB cases<ref name="pmid7377888">{{cite journal| author=Larrieu AJ, Tyers GF, Williams EH, Derrick JR| title=Recent experience with tuberculous pericarditis. | journal=Ann Thorac Surg | year= 1980 | volume= 29 | issue= 5 | pages= 464-8 | pmid=7377888 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7377888  }} </ref>
*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>
*Common findings on [[CT]] may include:
:*[[Lymphadenopathy]]
:*[[Pericardial]] thickening
:*[[Pericardial effusion]] may be present
*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.
 
*[[Lymph node]]s show central attenuation ([[caseating]] material) and peripheral enhancement (hypervascularity and inflammatory reaction).
*[[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>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Extranodal extension
*May present with mild symptoms, such as:
| style="padding: 5px 5px; background: #F5F5F5;" |
|}


<!--
:*Low-grade [[fever]]
Lymph Node Calcification and Extranodal Extension
:*[[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>


In the active stage, the nodes have central low attenuation and peripheral rim enhancement at CT, which correspond to caseation or liquefac- tion necrosis and granulation tissue with inflam- matory hypervascularity, respectively, at patho- logic analysis. With treatment, the nodes change in appearance, first becoming homogeneous and finally disappearing or resulting in a residual mass composed of fibrotic tissue and calcifications without low-attenuation areas (44,45) (Fig 16). Extranodal extension may occur into adjacent structures such as the bronchus, pericardium, and esophagus (Figs 17–21).
*[[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:


Esophagomediastinal Fistula
:*[[Mediastinal]] widening
:*Localized mass


Esophageal involvement by tuberculosis is rare. The most common cause of esophageal tubercu- losis is secondary involvement from adjacent tu- berculous lymphadenitis. Esophageal involvement results in strictures due to granulomatous inflammatory tissue in active disease and scar tis- sue after healing, tracheobronchial or mediastinal fistulas, and traction diverticula (8,46). Present- ing symptoms may include fever, cough, weight loss, dysphagia, chest discomfort, or back pain. The preferential involvement of the subcarinal region occurs mainly because of the anatomic proximity of the esophagus to diseased lymph nodes (47). When tuberculous lymph nodes erode the adjacent esophageal or bronchial wall, an esophagonodal or esophagobronchial fistula may be formed, which manifests as a localized gaseous collection within the mediastinum (46,47) (Figs 19, 20).
*[[CT]] findings may include:


Pericardial Tuberculosis
:*[[Hilar]] or [[mediastinal]] mass
Tuberculous pericarditis is reported to compli- cate up to 1% of cases of tuberculosis (48). Peri- cardial involvement is commonly caused by ex- tranodal extension of tuberculous lymphadenitis into the pericardium because of the close ana- tomic relationship between the lymph nodes and the posterior pericardial sac. The pericardium can also be involved in miliary spread of the disease (12). At CT, lymphadenopathy and pericardial thickening with or without effusion may be seen (Fig 21).
:*Calcification
:*[[Tracheobronchial]] narrowing
:*Obstruction of the [[superior vena cava]]
:*Pulmonary infiltrates


Constrictive pericarditis occurs in about 10% of patients with tuberculous pericarditis. It is characterized by fibrous or calcific constrictive thickening of the pericardium, which prevents normal diastolic filling of the heart (49). CT shows pericardial thickening of more than 3 mm with or without pericardial effusion. Secondary CT findings are dilatation of the inferior vena cava secondary to right-sided heart failure and acute angulation or sinus configuration of the in- terventricular septum, which may be related to redundancy of the septum secondary to the re- striction of expansion of the pericardium (49). Visceral pericardial calcification may occur at the atrioventricular grooves, the interventricular grooves, or especially the crux of the heart (49) (Fig 22).
*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>


Fibrosing Mediastinitis
:*Obstructive [[pneumonia]]
:*[[Atelectasis]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Extranodal extension
| style="padding: 5px 5px; background: #F5F5F5;" |
*Commonly affects the following structures:


Fibrosing mediastinitis is uncommon and in- volves the presence of excessive fibrosis in the mediastinum (50). Although tuberculosis is an important cause of chronic mediastinitis, tubercu- lous mediastinitis is rare; the most common cause of mediastinitis is histoplasmosis (51). Tubercu- lous mediastinitis progresses insidiously without significant clinical symptoms and may result in mild symptoms, including cough and low-grade fever, and symptoms due to compression of the superior vena cava, esophagus, and tracheobron- chial tree (52). The mediastinal granulomatous lymph nodes coalesce, and the development of multiple tuberculous granulomas creates both reactive fibrous changes and acute inflammatory changes in the mediastinum. The granulomas evolve into fibrosing mediastinitis when reactive changes predominate (50).
:*[[Bronchus]]
 
:*[[Pericardium]]
The radiographic findings include mediastinal widening or a localized mass. CT findings include a mediastinal or hilar mass, calcification in the mass, tracheobronchial narrowing, pulmonary vessel encasement, superior vena cava obstruc- tion, and pulmonary infiltrates (Fig 23). Pulmo- nary lesions in fibrosing mediastinitis may be caused by bronchial obstruction with subsequent obstructive pneumonia or atelectasis or by ob- struction of major pulmonary veins with resultant pulmonary infarction (50,52).
:*[[Esophagus]]
 
|}
-->


===Pleural Lesions===
===Pleural Lesions===
 
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center;" width="700px"
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
| 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:
:*Spontaneously
:*After trauma
:*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>
:*Acute phase - due to toxicity, [[tension pneumothorax]], or disease spread
:*Chronic phase - multiple seedings of [[bacteria]]
*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
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |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>
:*Rupture of a subpleural focus of infection
:*[[Lymph node]] infection caused by hematogenous dissemination
*Chronic [[empyema]] may follow tuberculous [[pleurisy]]
*CT findings in chronic tuberculous [[empyema]] may include:
:*Pleural thickening
:*Calcification
*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]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*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
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Fibrothorax]]
| style="padding: 5px 5px; background: #F5F5F5;" |
|}
|}


<!--
===Chest Wall Lesions===
Chronic Tuberculous
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center;" width="700px"
Empyema and Fibrothorax
| valign="top" |
Pleural infection is usually caused by rupture of a subpleural caseous focus into the pleural space; less commonly, it is caused by hematogenous dissemination and contamination by adjacent infected lymph nodes. Tuberculous pleurisy progresses to become chronic tuberculous empy- ema, which may be defined as persistent, grossly purulent pleural fluid containing tubercle bacilli (53–57). However, it may be difficult to culture the bacilli in chronic empyema.
|+
! style="background: #4479BA; width: 100px;" |{{fontcolor|#FFF|Complication}}
! 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: #F5F5F5;" |
*[[Blood|Hematogenous]] spread of pulmonary TB
*Commonly affected areas include:


In chronic tuberculous empyema, CT scans show a focal fluid collection with pleural thicken- ing and calcification and with or without ex- trapleural fat proliferation (Fig 24). Fibrothorax with diffuse pleural thickening but without effu- sion on CT scans suggests inactivity (Fig 24) (55– 57). Chyliform or pseudochylous pleural effusion is a high-lipid nonchylous effusion and is most commonly caused by tuberculous empyema. The diseased pleura may result in an abnormally slow transfer of cholesterol and other lipids, originating from degenerated red and white blood cells, out of the pleural space and lead to accumulation of cholesterol in the pleural fluid (58,59). CT shows a fat-fluid or fat-calcium level (Fig 25).
:*Lower [[thoracic vertebrae]]
:*Upper [[lumbar vertebrae]]


Bronchopleural Fistula
*[[X-ray]] findings in the early stage of the disease may include:
Bronchopleural fistula associated with tuberculo- sis usually follows trauma or a surgical procedure but can also occur spontaneously, presumably due to an open pathway between bronchus and pleura established by tuberculosis. High mortality can result from both the acute and chronic phases. The former occurs because of toxicity, spread of disease, and tension pneumothorax; the latter progresses to repeat small seedings and massive aspiration of empyema fluid (60). The diagnosis is based on an increasing amount of sputum production, air in the pleural space, a changing air-fluid level, and contralateral spread of pneumonic infiltration. CT can demonstrate the sites of communication between the pleural space and either one or more airways or the lung parenchyma in patients with bronchopleural fistula (61) (Fig 26).


Pneumothorax
:*Vertebral endplate irregularities
Pneumothorax secondary to tuberculosis often heralds severe and extensive pulmonary involve- ment by the infectious process and the onset of bronchopleural fistula and empyema. It occurs in approximately 5% of patients with postprimary tuberculosis, usually in severe cavitary disease (Fig 27) but rarely in miliary tuberculosis (Fig 28). The pathogenesis involves pleural caseous infiltrates that undergo liquefaction, resulting in pleural necrosis and rupture. If any apical abnor- mality is seen after reexpansion of a spontaneous pneumothorax, active tuberculosis should be con- sidered. In some cases, the lung will seal and re- expand over a long period in response to chemo- therapy. However, tube drainage is the treatment of choice (62,63).
:*Reduction of the intervertebral disk space
:*Adjacent bone sclerosis


-->
*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>


===Chest Wall Lesions===
:*Paravertebral abscess
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
:*Peripheral rim enhancement
|valign=top|
:*Area of low-attenuation at the center of the abscess, after enhancement
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Complication}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Description}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Tuberculous [[spondylitis]]
| style="padding: 5px 5px; background: #F5F5F5;" |
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Rib [[tuberculosis]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Rib tuberculosis
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*In the [[chest wall]], TB may involve:
:*[[Rib]]
:*[[Sternum]]
:*[[Sternoclavicular joint]]
*Characterized by:
:*[[Abscess]]es
:*Bone destruction
:*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
*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>
|-
|-
| 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]] (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>
Chest Wall Tuberculosis
 
Tuberculosis occasionally involves the sternum, the sternoclavicular joint, or a rib, leading to osse- ous destruction and localized abscess formation. Such involvement may occur by direct extension from a pleuropulmonary tuberculous lesion or
:*[[Malignant lymphoma]]
by hematogenous spread from a distant focus (64,65). When spontaneous discharge of empy- ema through the parietal pleura into the chest wall forms a subcutaneous abscess, it is termed empyema necessitatis (66).
:*[[Squamous cell carcinoma]]
:*[[Mesothelioma]]
:*[[Malignant fibrous histiocytoma]]
:*[[Liposarcoma]]
:*[[Rhabdomyosarcoma]]
:*[[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>
 
:*Prolonged [[inflammatory]] process in he case of [[malignant lymphoma]]
:*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]]
:*Increased [[thoracic cavity]] opacity
:*Medial deviation of the affected [[pleura]]
:Swelling of the soft-tissue


Tuberculosis of the chest wall is characterized by bone or costal cartilage destruction and soft- tissue masses that may demonstrate calcification or rim enhancement with or without evidence of underlying lung or pleural disease at CT (64,65) (Fig 29). Bone or cartilage may be intact in chest wall tuberculosis (64). Rarely, it is associated with development of retromammary or intramammary tuberculous abscesses (Fig 30).
*[[CT scan]] findings may include:
Tuberculous Spondylitis
Tuberculous spondylitis (Pott disease) is caused primarily by hematogenous spread of pulmonary infection and most commonly affects the lower thoracic and upper lumbar spine. The early radio- graphic manifestations of spinal involvement con- sist of irregularity of the vertebral end plates, de- creased height of the intervertebral disk space, and sclerosis of the adjacent bone. With progres- sion of disease, there is a tendency toward ante- rior wedging of the vertebral body, leading to ky- phosis and development of a paravertebral ab- scess. CT demonstrates paravertebral abscesses with peripheral rim enhancement and low-attenu- ation centers after enhancement (Fig 31) (67– 69).


Malignancy Associated with Chronic Empyema
:*Enhancement of a mass around the region of the [[empyema]]
Malignancy associated with chronic empyema, especially tuberculous empyema, is rare (70 –72). The mean duration of chronic empyema before diagnosis of malignancy is reported to be about 25 years. The histopathologic diagnoses in re- ported cases have been malignant lymphoma, squamous cell carcinoma, mesothelioma, malig- nant fibrous histiocytoma, liposarcoma, rhabdo- myosarcoma, angiosarcoma, and hemangioendo- thelioma, in order of frequency (72). The patho- genesis of malignancy developing in chronic empyema may be a long-standing severe inflam- matory process of a nonautoimmune nature in malignant lymphoma or chronic stimulation of mesothelial cells or the action of oncogenic sub- stances contained in the pleura in other malig- nancy, including mesothelioma (70,71,73).
:*Attenuation of soft tissues surrounding the [[empyema]]
Radiographic findings that suggest the occur- rence of malignancy include increased opacity in the thoracic cavity, soft-tissue bulging and blur- ring of fat planes in the chest walls, destruction of bone near the empyema, and extensive medial deviation of the calcified pleurae (72). CT can demonstrate an abnormal mass with soft-tissue attenuation around the empyema and usually shows enhancement of the mass (Fig 32). Biopsy is necessary because differentiation between ma- lignancy and infection is rather difficult.


-->
*Perform [[biopsy]] to differentiate between [[infection]] and [[malignancy]]
|}


==Prognosis==
==Prognosis==
If untreated, active tuberculosis 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 adequate treatment, these patients have a good [[prognosis]].<ref name="Harrisons"></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>
*[[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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[[Category:Bacterial diseases]]
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[[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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