Progressive Primary Tuberculosis

Images

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Clinical History:

14 year-old female with lack of appetite, loss of weight and cough without sputum.


Findings:

İmage1: Chest radiograph of the left lung shows diffuse small nodules ( in millimeter range), that are typically seen in miliary tuberculosis.
İmage2: CT scan obtained with lung windowing demonstrates numerous nodules (in millimeter range). Also note patchy consolidations in bilateral posterior segments of the upper lobes.
İmage3: CT scan obtained with mediastinal window shows subcarinal lymphadenopathy.


Diagnosis:

Progressive Primary Tuberculosis


Discussion:

Clinical and radiologic features of tuberculosis vary depending on which organ system affected. Furthermore, it can mimic many other diseases (1,2).

Pulmonary tuberculosis is classically divided into primary and postprimary (reactivation) tuberculosis. Primary tuberculosis is most common in infants and children, so it has been considered a disease of childhood. Radiologic manifestations of primer tuberculosis are parenchymal disease, lymphadenopathy, miliary disease, atelectasis and pleural effusion (1, 2). However, chest radiograph may be normal in 15% of cases (3).

Progressive primary tuberculosis is observed in 5-10% of patients with primary tuberculosis. It is most commonly seen in children younger than 1 year of age, teenagers and in black people. The radiological features of progressive primary tuberculosis are similar to postprimary tuberculosis. İn both entities, findings of parenchymal disease are patchy consolidation (particularly in the apical and posterior segments of the upper lobes) and cavitation (2, 4).


References / Suggested Reading:

1- Mukesh G. Harisinghani, et al, Tuberculosis from head to toe, RadioGraphics 2000; 20:449–470.
2- Joshua Burrill, et al, Tuberculosis: A Radiologic Review, RadioGraphics 2007; 27:1255–1273.
3- Miller WT, Miller WT Jr. , Tuberculosis in the normal host: radiological
findings. Semin Roentgenol 1993; 28:109–118.
4- C. Beigelman, D. Sellami, M. Brauner, CT of parenchymal and bronchial tuberculosis, Eur. Radiol. 10, 699-709 (2000).


Author

Abidin KILINCER

Resident

University of Hacettepe

Joined: 12/10/2009
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Dr.Yakup YEŞİLKAYA

Hacettepe Medical School Department of Radiology ANKARA