Primary tuberculosis

• Lymphadenopathy.—Mediastinal and hilar lymphadenopathy is the

most common radiologic manifestation of primary tuberculosis (2)

demonstrates a low-attenuation center with

peripheral rim enhancement on contrast material–
enhanced CT images
Parenchymal Disease
• Parenchymal disease most
frequently manifests as
consolidation depicted as an
area of opacity in a segmental
or lobar distribution
• Parenchymal disease often
appears similar to bacterial
pneumonia, but the presence
of lymphadenopathy can be a
clue that points toward
primary tuberculosis
Pleural Effusion.
• Tuberculous pleural effusions usually
result from hypersensitivity to
tuberculous protein, rather than frank
pleural infection;
• Cytologic examination of the pleural
fluid typically reveals predominantly
lymphocytes; certain fluid studies, such
as determining the fluid level of
adenosine deaminase, a marker of
monocytes and macrophages, are
useful in the diagnosis of tuberculous
effusions
Airway Disease
• —Bronchial wall involvement may
be seen in primary and postprimary
tuberculosis, although it is more
common in the former
• The main radiographic features of
proximal airway involvement are
indirect, including segmental or
lobar atelectasis (Fig 7a), lobar
hyperinflation, mucoid impaction,
and postobstructive pneumonia.
Miliary Tuberculosis
• Hematogenous dissemination results in
miliary tuberculosis, especially in
immunocompromised and pediatric
patients
• On the chest radiograph or CT image,
miliary disease manifests as diffuse 1–3-
mm nodules in a random distribution (Fig
9). Miliary tuberculosis is spread by
hematogenous seeding, as demonstrated
by the finding of a miliary nodule
centered on a small blood vessel (Fig 10).
Postprimary Tuberculosis
• Postprimary tuberculosis is typically
thought to result from reactivation of
dormant M tuberculosis
• A chest radiograph is typically obtained to
evaluate for findings of active disease.
Chest CT may be useful in identifying
active tuberculosis even if the chest
radiograph is negative, although chest CT is
not the standard of practice
 Consolidation and Cavitation.—
• Patchy, poorly marginated
consolidation is an early and
consistent feature of postprimary
tuberculosis (Fig 11)
• s. Cavities can be several
centimeters in largest dimension
and can develop thick and irregular
walls (Figs 12, 13)