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1、JayShendure,HMS3September2005GillianLieberman,MDPulmonaryTuberculosis-TwoContrastingPresentationsJayShendure,HMSIIIGillianLieberman,MDCoreRadiologyClerkship,BIDMCJayShendure,HMS3GillianLieberman,MDTB:Epidemiology8millioncases/year(~284inMassachusetts)Primaryinfection(~70-90
2、%asymptomatic)→Latency1%riskofreactivationperyear(10%withHIV)TypicalHPI:feverweightlosscoughnight-sweatsanorexiahemoptypsis50%fatalityifuntreatedJayShendure,HMS3GillianLieberman,MDPulmonaryManifestationsofTB71%pulmonaryinvolvementonly20%extrapulmonaryinvolvementonly9%pulmon
3、aryandextrapulmonaryinvolvmentAyala&Speilberg,Boards&Wards(2003)JayShendure,HMS3GillianLieberman,MDTypicalCXRFindingsinTBACTIVELATENTLungConsolidationScarringCavitiesVolumeLossFocalNodulesDestroyedLobeMiliaryNodularPatternHilumLymphadenopathyCalcifiedLNs(Ghon!)PericardialCa
4、lcificationPleuraEffusion/empyemaPleuralThickeningPleuralCalcificationJayShendure,HMS3GillianLieberman,MDPatient1:ClinicalPresentation28y/omalewithahistoryofbronchitisPresentedatEDHPI:Night-sweats,fever,non-productivecoughJayShendure,HMS3GillianLieberman,MDPatient1:LULconfl
5、uentairspaceopacitiesBIDMC/PACSJayShendure,HMS3GillianLieberman,MDSegmentalconsolidationDDxLobarPneumoniaBronchopneumoniaInterstitialPneumoniaAspirationTBorAtypicalMycobacteriumTraumaPulmonaryEmbolismObstructingNeoplasmMitralRegurgitationJayShendure,HMS3GillianLieberman,MDP
6、atient1Historyisimportant!6yearsago,patientPPDconvertedafteratriptoZimbabweCXRreadchangedatdictationtoTBuntilprovenotherwiseButnocavitarylesions,etc,toclearlydistinguishfromcommunity-acquiredpneumoniaJayShendure,HMS3GillianLieberman,MDPatient1:RxDischargedonlevaquin,toldtow
7、earmaskSputumobtainedbybronchoscopy→AFB+StartedonstandardTBtherapyCultureturnedouttobepan-sensitiveFollow-upCXRstomonitorimprovementJayShendure,HMS3Patient1:CXRfollowupGillianLieberman,MDBIDMCPACSJayShendure,HMS3Patient1:CXRfollowupGillianLieberman,MD1monthlaterBIDMCPACSJay
8、Shendure,HMS3Patient1:CXRfollowupGillianLieberman,MD6wkslaterBIDMCPACSJayShendure,
