Ro TB in Children

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mts darmawan

Rontgenologies of Tuberculosisin Children

Learningradiology.com


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Normal Rontgenography


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Normal CXR


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Normal Adult CXR

Male Female


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Normal Ro in Children

Kunci :

para hiler &

infrahiler bersih


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Right Lateral

TB Normal

Lurus. bersih

Infrahilaradenopathy


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1st Pulmonary Tuberculosis

Patterns

Pneumonia Lymphadenopathy Atelectasis

Pleural effusion


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Looking for TB Rontgenologis

in Children

Should be :

Antero-Posterior, AND Right Lateral


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Ghon focus


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Primary Tuberculosis

Pneumonia

Upper lobes affected slightly more than lower

Pneumonia common Cavitation is rare

Lobar pneumonia almost always associated

with lymphadenopathy Infiltrate + ipsilateral adenopathy : think TB


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Primary Tuberculosis

Adenopathy

Unilateral hilar and / or paratracheal

Usually right-sided Rarely bilateral

Differentiates 1 from 2 does not

occur in post primary TB Adenopathy much more common in

children


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Lymphadenopathy


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Lymphadenopathy


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Lymphadenopathy


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Lymphadenopathy

Buntu


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Lymphadenopathy


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Lymphadenopathy


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Primary Tuberculosis Atelectasis

Classically affects

anterior segments

of upper lobes, or

Medial segment of

the RML


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Pleural Effusion


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Pleural Effusion


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Primary Tuberculosis General

Calcification in 1complex is relatively

rare

Few patients with 1TB have clinical

manifestations


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Post primary Tuberculosis

Reactivation TB


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Reactivation TB General

Most cases in adults occur as reactivation

of 1 focus of infection acquired in childhood

Caseous necrosis & tubercle are pathologichallmarks of post 1 TB

Tubercle = accumulations of mononuclear

macrophages, Langhans giant cellssurrounded by lymphocytes / fibroblasts


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Reactivation TB General

Healing occurs with fibrosis and

contraction

Calcification is rarer than in 1 Limited mainly to apical & posterior

segments of upper lobes & superior

segments of lower lobe


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Reactivation TB Patterns

Pneumonia

Cavity formation

Transbronchial spread Bronchiectasis

Bronchostenosis

Pleural disease Tuberculoma

Bone involvement


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Cavity


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Cavity


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Cavity


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Affects apical or posterior segments of

upper lobes or superior segments of lower

lobes

Bilateral upper lobe disease is very

common

May present as pneumonia

Cavitation may result

Cavity is usually thin-walled, smooth oninner margin with no air-fluid level


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Transbronchial spread may occurfromone upper lobe to opposite lower Bronchiectasisusually asymptomatic

Bronchostenosis due to fibrosis andstricture Fibrosis may cause distortion of a bronchus

and atelectasis many years after initialinfection = middle lobe syndrome

Middle Lobe Syndromes


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Middle Lobe Syndromes

=Middle Lobe Atelectasis + Hilar Lymphadenopathy


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Pleural effusion in postprimary TB Almost always means direct spread ofdisease in to pleural cavity

Should be regarded as an empyema Carries a graver prognosis than effusion of1 form

Direct extension into ribs orsternoclavicular joints is uncommon


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Solitary pulmonary nodule Tuberculoma May occur in either 1 or postprimary

disease Round or oval lesions with small, discreteshadows in immediate vicinity of

lesion=satellite lesion

Mili T b l i


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Miliary Tuberculosis


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Miliary Tuberculosis General

Hematogenous dissemination of bacillicommon in 1 TB but clinically evident

miliary TB rarely occurs

May not manifest itself for many yearsafter infection


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Miliary Tuberculosis General


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Miliary Tuberculosis Clinical

Older men, Blacks and pregnant womensusceptible Onset is insidious Fever, chills, night sweats are common Takes weeks between time ofdissemination and radiographic

appearance of disease


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Miliary TB Natural History

When 1st visible, measure about 1 mm insize

Frequently missed on first films Can grow to 2-3mm if left untreated

When treated, clearing is rapid

Miliary TB does NOT heal withcalcification


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Calcification in TB 3 Funny Names

1. Ghonlesion = calcified granuloma

2. Ranke complex = Ghon lesion + calcifiedlymph node

3. Simon focus = healed site of 1infection at lung apex


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Ghons Complex

Ghons complex Complicated Ghon Focus


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Calcification


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TB and Other Diseases

Occurs with a higher incidence in sarcoid-especially if rx with steroids Associated with silicosis Associated with HIV infection No relationship with bronchogenic Ca


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TB and AIDS

Mycobacterium avium-intracellulare(MAI)is more common than TB TB in AIDS looks like 1 form Hilar and mediastinal adenopathycommon

Cavitation less common No predilection for apices


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TB : The Question of Activity

Only serial images with no change cansuggest lack of activity2 years In presence of cavities, activity must bedetermined clinically


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Tuberculosis Ancient Remedies

Rest Theory

Ping-pong ball plumbage Paraffin plumbage Oleothorax Pneumothorax andpneumoperitoneum Thoracoplasty


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Thank You

Ro TB in Children

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