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Case Discussion 1
JACINTO, Ma. Theresa
JEONG, Kyung Sun
JOSE, Niña
JUNIA, Christine Joy
KING KAY, Caroline Bernadette
LAO, Eugene
LAO, Kriselle Maris
LAO, Lawrence Edeniño
LAO, Sharlene Marie
LAUS, Lady Diana Rose
III - C
CASE
RR, 70 years old, male, seaman
Chief complaint: Cough
History of Present Illness
3 years PTC
Productive cough with whitish phlegm
Accompanied by fever and body malaise
Self-medicated with paracetamol and
amoxicillin (unrecalled dosage)
History of Present Illness
2 years PTC
Persistence of cough, now blood tinged
Sought consult, was advised to have chest x-
ray.
Was given anti-TB regimen but unable to
comply with the full course of treatment
History of Present Illness
1 year PTC
Occasional cough and febrile episodes
No medications taken
3 days PTC
Expectorated blood
Advised to have chest CT scan
Review of Systems
(+) weight loss
(+) loss of appetite
(+) body malaise
(+) night sweats
Past Medical History
(+) Hypertension
Physical Examination
Hyposthenic
Normal Vital Signs
Lagging of the left lung
Diminished breath sounds on the left
Normal Patient
Chest PA Lateral
Learning Issues
Radiographic signs of PTB
What is a tuberculoma?
Distinguish between primary vs re-infection
tuberculosis
Explain the presence of atelectasis, cavitations
and bronchiectasis in PTB
What is the role of follow-up chest x-ray?
Radiographic findings of healed PTB
What is the role of CT scan?
OUTLINE
Pathophysiology of Tuberculosis
Radiographic Signs of PTB
Tuberculoma
Bronchiectasis
Cavitation
Atelectasis
Primary vs. Re-infection PTB
Active vs. Healed PTB
Role of Chest X-Ray in Follow-up
Role of CT Scan
OUTLINE
Pathophysiology of Tuberculosis
Radiographic Signs of PTB
Tuberculoma
Bronchiectasis
Cavitation
Atelectasis
Primary vs. Re-infection PTB
Active vs. Healed PTB
Role of Chest X-Ray in Follow-up
Role of CT Scan
Infection with
M. tuberculosis
Tissue-damaging Macrophage-activating
response response
Intensified DTH
Tissue-damaging
response
Multiplication &
• Cough
Caseous material Drained through spread of the
• Hemoptysis
liquefies bronchi bacilli into the
airways
Cavity formation
OUTLINE
Pathophysiology of Tuberculosis
Radiographic Signs of PTB
Tuberculoma
Bronchiectasis
Cavitation
Atelectasis
Primary vs. Re-infection PTB
Active vs. Healed PTB
Role of Chest X-Ray in Follow-up
Role of CT Scan
Tuberculoma
Primary, post-primary
tuberculosis
Form of lesion
commonly seen in TB
Well circumscribed,
round/oval opacities
caused by acid-fast
bacilli
1-4 cm or more in
diameter
mostly in upper lobe,
right more than the left
Tuberculoma
OUTLINE
Pathophysiology of Tuberculosis
Radiographic Signs of PTB
Tuberculoma
Bronchiectasis
Cavitation
Atelectasis
Primary vs. Re-infection PTB
Active vs. Healed PTB
Role of Chest X-Ray in Follow-up
Role of CT Scan
Bronchiectasis
Localized, irreversible
dilatation of the
bronchial tree
Associated with
acute, chronic or
recurrent infection
(bacteria and
mycobacteria)
Bronchiectasis
Tram line
Ring shadows with thickened bronchial walls
Mucus plugs
Bronchiectasis
Bronchial dilatation
Tram lines
Thickened bronchial walls
Mucus plugs
OUTLINE
Pathophysiology of Tuberculosis
Radiographic Signs of PTB
Tuberculoma
Bronchiectasis
Cavitation
Atelectasis
Primary vs. Re-infection PTB
Active vs. Healed PTB
Role of Chest X-Ray in Follow-up
Role of CT Scan
Cavitations
Cavitation, usually in the apices of the
lungs, occurs readily in the secondary
form of PTB, resulting in dissemination of
mycobacteria along the airways
CAVITY
OUTLINE
Pathophysiology of Tuberculosis
Radiographic Signs of PTB
Tuberculoma
Bronchiectasis
Cavitation
Atelectasis
Primary vs. Re-infection PTB
Active vs. Healed PTB
Role of Chest X-Ray in Follow-up
Role of CT Scan
Atelectasis
“Incomplete
stretching”, loss of
volume of lung tissue
because of decreased
amount of gas
Destructive process in
the walls of the
bronchi and plugging
of the lumina by
exudate
Radiology of the chest. Regional roentgen pathology. pp. 365-367
Thoracic Imaging: Pulmonary and Cardiology. pp. 47-65
Direct Signs ( due to lobar volume loss)
Displacement of interlobular fissures: best sign of
atelectasis
Crowding of vessels, bronchi or air bronchograms
Radiology of the chest. Regional roentgen pathology. pp. 365-367
Thoracic Imaging: Pulmonary and Cardiology. pp. 47-65
Indirect Signs
Diaphragmatic elevation: due to ipsilateral volume
loss: more common lower lobe
Juxtaphrenic Peak (upper lobe atelectasis)
Radiology of the chest. Regional roentgen pathology. pp. 365-367
Thoracic Imaging: Pulmonary and Cardiology. Pp. 47-65
Indirect Signs
Mediastinal shift:
more common upper
lobe collapse
(Trachea); more
common lower lobe
collapse (heart)