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Update: The Radiographic Features of Pulmonary Tuberculosis

Pulmonary tuberculosis produces a broad spectrum of radiographic abnormalities. During the primary phase of the disease these include pulmonary consolidation (50%), which often involves the middle or lower lobes or the anterior segment of an upper lobe; cavitation (29%) or pneumatocele formation(12%); segmental orlobar atelectasis(18%); pleural effusion (24%); hilar and mediastinal lymphadenopathy (35%); disseminated miliary disease (6%); and a normal chest radiograph (15%). During the postprimary phase of the disease, common abnormalities include exudative and/or fibroproductive parenchymal densities (100%), predominantly in the apical and posterior segments of the upper lobes (91%); cavitation (45%) with bronchogenic spread of disease (21%); marked fibrotic response in the lungs (29%); and pleural effusion,. | 497 Update The Radiographic Features of Pulmonary Tuberculosis John H. Woodring1 H. Mac Vandiviere2 Andrew M. Fried1 Marcus L. Dillon3 Terry D. Williams1 Irene G. Melvin2 Pulmonary tuberculosis produces a broad spectrum of radiographic abnormalities. During the primary phase of the disease these include pulmonary consolidation 50 which often involves the middle or lower lobes or the anterior segment of an upper lobe cavitation 29 or pneumatocele formation 12 segmental or lobar atelectasis 18 pleural effusion 24 hilar and mediastinal lymphadenopathy 35 disseminated miliary disease 6 and a normal chest radiograph 15 . During the postprimary phase of the disease common abnormalities include exudative and or fibroproductive parenchymal densities 100 predominantly in the apical and posterior segments of the upper lobes 91 cavitation 45 with bronchogenic spread of disease 21 marked fibrotic response in the lungs 29 and pleural effusion empyema and fibrosis 18 4 and 41 respectively . Upper-lobe masslike lesions are seen occasionally 7 spontaneous pneumothorax and intrathoracic lymphadenopathy are rare 5 each . Common causes of a missed diagnosis of tuberculosis are 1 failure to recognize hilar and mediastinal lymphadenopathy as a manifestation of primary disease in adults 2 exclusion of tuberculosis because disease predominates in or is limited to the anterior segment of an upper lobe or the basilar segment of a lower lobe 3 overlooking of minimal fibroproductive lesions or reporting them as inactive 4 failure to recognize that an upper-lobe mass surrounded by satellite fibroproductive lesions might be tuberculous and 5 failure to consider healed sequelae of primary disease or a positive purified protein derivative skin test as contributory to identifying the patient s pulmonary disease. Received April 15 1985 accepted after revision November 4 1985. 1 Department of Diagnostic Radiology Albert B. Chandler Medical Center University of Kentucky College of Medicine 800 Rose