Pulmonary tuberculosis
Tomographic evaluation in the active and post-treatment phases
Keywords:
Tuberculosis, Computed x-ray tomography, DiagnosisAbstract
CONTEXT: Adequate knowledge of images consistent with tuberculosis activity is an important resource for tuberculosis diagnosis and treatment. OBJECTIVE: To evaluate the structural alterations caused by tuberculosis in the pulmonary parenchyma, both during the active phase of the disease and after the end of the treatment, through computerized tomography of the thorax. TYPE OF STUDY: Prospective study. SETTING: Pulmonary Division, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo. PARTICIPANTS: 20 patients, carriers of pulmonary tuberculosis, confirmed by Mycobacterium tuberculosis culture. PROCEDURES: Conventional tomography scans of the patients were obtained at two times: upon diagnosis and after the end of the treatment. The following were considered suggestive signs of tuberculosis activity: centrilobular nodules with segmented distribution, confluent micronodules, consolidations, thick-walled cavities, nodules, masses, thickening of the bronchial walls, tree-in-bud appearance and cylindrical bronchiectasis. MAIN MEASUREMENTS: The presence of suggestive signs of tuberculosis activity was compared between the start and the end of treatment by means of the signs test (z). RESULTS: All patients (20/20) presented suggestive signs of tuberculosis activity at the start of treatment. After the end of treatment, 13 patients (13/ 20) still presented some suggestive signs consistent with activity. A reduction in the extent of lung attack was seen post-treatment, in relation to its start (z = 10.10). This change was statistically significant (p < 0.001). CONCLUSION: Signs suggestive of tuberculosis activity are present in the active disease and are seen via computed tomography. The extent of parenchymal attack significantly decreases following treatment. Such signs may be useful in the diagnosis of pulmonary tuberculosis.
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References
World Health Organization. Global Tuberculosis Control: Sur- veillance, Planning, Financing. WHO Report 2002. Available from: URL: http://www.who.int/gtb/publications/globrep02/ contents.html. Accessed on 10/07/03.
Bombarda S, Figueiredo CM, Funari MBG, Soares-Júnior J, Seiscento M, Terra-Filho M. Imagem em tuberculose pulmonar. J Pneumol 2001;27(6):329-40.
Brasil. Ministério da Saúde. Plano Nacional de Controle da Tuberculose. Manual de normas para o controle da tuberculose. Brasília: Ministério da Saúde; 2000.
Goo JM, Im JG. CT of tuberculosis and nontuberculous myco- bacterial infections. Radiol Clin North Am 2002;40(1):73-87.
Campos CA, Marchiori E, Rodrigues R. Tuberculose pulmonar: achados na tomografia computadorizada de alta resolução do tórax em pacientes com doença em atividade comprovada bacteriologicamente. J Pneumol 2002;28(1):23-9.
Lee KS, Hwang JW, Chung MP, Kim H, Kwon OJ. Utility of CT in the evaluation of pulmonary tuberculosis in patients with- out AIDS. Chest 1996;110(4):977-84.
Hatipoglu ON, Osma E, Manisali M, et al. High resolution computed tomographic findings in pulmonary tuberculosis. Thorax 1996;51(4):397-402.
Lee KS, Im JG. CT in adults with tuberculosis of the chest: characteristic findings and role in management. AJR Am J Roentgenol 1995;164(6):1361-7.
Im JG, Itoh H, Shim YS, et al. Pulmonary tuberculosis: CT findings - early active disease and sequential change with an- tituberculous therapy. Radiology 1993;186(3):653-60.
Leung AN. Pulmonary tuberculosis: the essentials. Radiology 1999;210(2):307-22.
McAdams HP, Erasmus J, Winter JA. Radiologic manifesta- tions of pulmonary tuberculosis. Radiol Clin North Am 1995;33(4):655-78.
Lee KS, Song KS, Lim TH, Kim PN, Kim IY, Lee BH. Adult- onset pulmonary tuberculosis: findings on chest radiographs and CT scans. AJR Am J Roentgenol 1993;160(4):753-8.
Bombarda S, Figueiredo CM, Seiscento M, Terra-Filho M. Estudo comparativo entre a radiografia e a tomografia compu- tadorizada de tórax na forma ativa da tuberculose pulmonar. J Pneumol 2000;26(Suppl 3):S18.
Capellozi, VL. Tuberculose. In: Brasileiro-Filho G, Bogliolo L, editors. Patologia. 6a ed. Rio de Janeiro: Guanabara Koogan; 2000. p.320-2.
Tuddenham WJ. Glossary of terms for thoracic radiology: rec- ommendations of the Nomenclature Committee of the Fleischner Society. AJR Am J Roentgenol 1984;143(3):509-17.
Souza-Júnior AS, Araujo CN, Jasinovodolinsky D, et al. Terminologia para a descrição de tomografia computadorizada de tórax: sugestões iniciais para um consenso brasileiro. [Ter- minology for the description of the thoracic computed tomog- raphy: first suggestions for a brazilian consensus]. Radiol Bras 2002;35(2):125-8.
Rook GW, Zumla A. Advances in the immunopathogenesis of pulmonary tuberculosis. Curr Opin Pulm Med 2001;7(3):116-23.
Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH. Tho- racic sequelae and complications of tuberculosis. Radiographics 2001;21(4):839-58; discussion 859-60.
Collins J. CT signs and patterns of lung disease. Radiol Clin North Am 2001;39(6):1115-35.
Lee JY, Lee KS, Jung KJ, et al. Pulmonary tuberculosis: CT and pathologic correlation. J Comput Assist Tomogr 2000;24(5):691-8.
Miller WT, MacGregor RR. Tuberculosis: frequency of unu- sual radiographic findings. AJR Am J Roentgenol 1978;130(5):867-75.
Kim HY, Song KS, Goo JM, et al. Thoracic sequelae and com- plications of tuberculosis. Radiographics 2001;21(4):839-58; discussion 859-60.