Pulmonary Tuberculosis

Abstract

This review on pulmonary tuberculosis includes an introduction that describes how the lung is the portal of entry for the tuberculosis bacilli to enter the body and then spread to the rest of the body. The symptoms and signs of both primary and reactivation tuberculosis are described. Routine laboratory tests are rarely helpful for making the diagnosis of tuberculosis. The differences between the chest X ray in primary and reactivation tuberculosis is also described. The chest computed tomography appearance in primary and reactivation tuberculosis is also described. The criteria for the diagnosis of pulmonary tuberculosis are described, and the differential is discussed. The pulmonary findings of tuberculosis in HIV infection are described and differentiated from those in patients without HIV infection. The occurrence of tuberculosis in the elderly and in those patients on anti-tumor necrosis factor alpha inhibitors is described. Pleural tuberculosis and its diagnosis are described. Efforts to define the activity of tuberculosis and the need for respiratory isolation are discussed. The complications of pulmonary tuberculosis are also described.

FIGURE 1

Primary tuberculosis in an adult. Shown is a right lower lobe infiltrate with bilateral hilar adenopathy.

FIGURE 2

Left upper lobe tuberculosis. Shown is a typical fibronodular pattern of reactivation tuberculosis with linear densities extending to the left hilum.

FIGURE 3

Late changes of upper lobe tuberculosis. (A) Posterior-anterior chest radiograph with volume loss of the right upper lobe indicated by the elevated minor fissure. Small cavities are not clearly visible, but there is endobronchial spread to the superior segment of the right lower lobe, suggesting cavitary formation. (B) A CT scan of the same patient that clearly demonstrates extensive bilateral cavitary disease.

FIGURE 4

Miliary tuberculosis. (A) Characteristic diffuse small nodules are seen in the posterior-anterior radiograph. (B) CT scan of the lung in the same subject demonstrates the diffuse small nodular disease.

FIGURE 5

Tuberculous empyema. Posterior-anterior (A) and lateral (B) chest radiographs demonstrate a left lower lobe effusion.