ATYPICAL RADIOLOGICAL MANIFESTATIONS OF ACTIVE PULMONARY TUBERCULOSIS IN SERIES OF PATIENTS FROM NORTH MACEDONIA ON COMPUTED TOMOGRAPHY
Keywords:
tuberculosis (TB), computed tomography (CT), North Macedonia, clusters of micronodules, cystic patterns of PTB, non- military nodulesAbstract
Immunocompromised and patients with chronic diseases worldwide, as well as from North Macedonia, have a greater probability of acquiring tuberculosis (TB) in their lifetime, which is caused by the mycobacterial species and still represents one of the major burdens of the public health systems, as well as one of the most frequent causes of death. The disease itself can manifest in two forms, active and dormant. The active form of the disease manifests shortly after acquiring the infection, whilst the dormant one can occur after years of latency as a postprimary form. Negative microbiology results in tuberculous patients can delay and complicate the accurate diagnosis, so the diverse diagnostic imaging modules, especially the computed tomography (CT), have a supreme role in diagnosing, and following patients with pulmonary tuberculosis (PTB) after treatment.
Purpose: Our aim was to illustrate and analyze some atypical appearances of active pulmonary tuberculosis (PTB) in series of 30 patients from North Macedonia on computed tomography (CT).
Methodology: 30 consecutive chest CT scans of patients with microbiologically proven tuberculosis from North Macedonia were thoroughly analyzed. All patients underwent a non- contrast and then a contrast enhanced chest CT according to appropriate diagnostic protocol on a 64-slice Somatom Definition AS + computed tomograph (Siemens Healthineers, USA). We reviewed 30 CT scans and all the available information from the medical history of the patients, including their microbiology results.
Results: Some of the uncommon signs of PTB we observed on the CTs included: (1) various clusters of micronodules; (2) cystic patterns in PTB patients; (3) PTB with diffusely scattered non miliary nodules, (4) PTB in the setting of COVID 19 pneumonia, (5) organizing pneumonia.
Conclusion: Aside from the obvious decrease of the PTB incidence globally, there is an evident rise of atypical manifestations, clinically and on imaging. Mastering the knowledge of atypical CT imaging signs in active PTP will help in reaching diagnosis, following treatment response or residual activity of PTP in clinical practice. Diagnostic imaging also aids the detection of complications or sequels from the disease.
References
Ariyürek, M.O., Karçaaltincaba, M., Demirkazik, F.B., Akay, H., Gedikoglu, G., & Emri, S. (2002). Bilateral multiple pulmonary tuberculous nodules mimicking metastatic disease. Eur J Radiol 44:33-6.
Hong, J.H., Yoon, S.H., Goo, J.M., Yim, J.J., & Jeon, Y.K. (2020). Clustered micronodules as predominant manifestation on CT: A sign of active but indolently evolving pulmonary tuberculosis. PLoS One 15:e0231537.
Heo, J.N., Choi, Y.W., Jeon, S.C., & Park, C.K. (2005). Pulmonary tuberculosis: another disease showing clusters of small nodules. AJR Am J Roentgenol 184:639-42.8.
Hsieh, M.H., & Lin, C.Y. (2014). Pulmonary tuberculosis presenting as organizing pneumonia. Am J Respir Crit Care Med 189:e63.
Kim, Y.C., Jang, A.S., Kim, J.S., Oh, S.H., Lee, Y.Y., Son, J.G., Sun, H.J., & Lee, J.I. (2002).A case of pulmonary tuberculosis following bronchiolitis obliterans with organizing pneumonia (BOOP). Chonnam Med 38:170-4.
Kobashi, Y., Mouri, K., Fukuda, M., Yoshida, K., Miyashita, N., & Oka, M. (2008). Transitional change in the clinical features of pulmonary tuberculosis. Respiration 75:304-9.
Kobashi, Y., Mouri, K., Yagi S, Obase, Y., Miyashita, N., Okimoto, N., Matsushima, T., & Oka, M. (2007). Clinical features of immunocompromised and nonimmunocompromised patients with pulmonary tuberculosis. J Infect Chemother 13:405-10.
Kligerman, S.J., Franks, T.J., & Galvin, J.R. (2013). From the radiologic pathology archives: organization and fibrosis as a response to lung injury in diffuse alveolar damage, organizing pneumonia, and acute fibrinous and organizing pneumonia. Radiographics 33:1951-75.
Ko, K.S., Lee, K.S., Kim, Y., Kim, S.J., Kwon, O.J., & Kim, J.S.(1997). Reversible cystic disease associated with pul Oikonomou, A., & Hansell, DM.(2002).Organizing pneumonia: the many morphological faces. Eur Radiol 12:1486-96.monary tuberculosis: radiologic findings. Radiology ;204:165-9.
Oikonomou, A., & Hansell, D.M. (2002). Organizing pneumonia: the many morphological faces. Eur Radiol 12:1486-96.
Suzuki, A., Hujita, A., Yamamoto, H., Ohtsuka, T., Tokuda, H., & Suyama, T. (1999). Pulmonary Tuberculosis Presenting Multiple Nodular Shadows in 4 Patients. Nihon Kokyuki Gakkai Zasshi 37:538-42
Self-study modules on tuberculosis. Centers for Disease Control and Prevention website. https://www.cdc.gov/tb/topic/basics/default. Last reviewed February (2022). Last accessed March 7, 2022.
WHO Global tuberculosis report (2021). https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2021. Last updated October 14, 2021. Last accessed March 7, 2022.
Yoon, H.S., Lee, E.J., Lee, J.Y., Chon, G.R., Lee, S.H., & Kim, S.J. (2015).Organizing pneumonia associated with Mycobacterium tuberculosis infection. Respirol Case Rep 3:128-31.
Zhao, F., Yan, S.X., Wang, G.F., Wang, J., Lu, P.X., Chen, B., Yuan, J., Zhang, S.Z., & Wang, Y.X. (2014). CT features of focal organizing pneumonia: an analysis of consecutive histopathologically confirmed 45 cases. Eur J Radiol 83:73-8.
