(no consultations)
Atypical tuberculosis (MAI, MAC)
TB in right upper lobe with a characteristic mixture of ill defined inflammatory exudation, circumscribed productive foci, and cavitation.
Mixed appearance of TB in right upper lobe with exudation, productive foci and cavities.
Newly developing tuberculous infiltration at left.
Follow up of a healing small tuberculous infiltration in left upper lobe.
CT of tuberculous exudation in right upper lobe.
High Resolution Computed Tomography (HRCT) of tuberculous infiltrate: ill defined centrilobular nodules with "tree-in-bud" appearance of tuberculous consolidation. This appearance is frequent in atypical TB.
TB infiltration with "tree in bud". 8 mm scan.
"Tree in bud" appearance in 8 mm thick scan slice. It is no longer visible in 2-mm scans. Now, centrilobular emphysema is prominent.
Exudative TB focus in RUL and regression after therapy.
Young mother with productive TB in LUL (her baby contracted the disease and developed miliary TB).
Chest film and CT of productive TB with multiple well defined nodules (nodules of miliary TB would be smaller - see below)
Exudative and productive TB in RUL and healing with therapy.
Change of appearance of productive-cavernous TB into cavernous-fibrotic TB with therapy.
Cavity in LUL, chest film and CT. Chest x-ray after healing with fibrosis.
Development of cavity with air-fluid-level in LUL.
Chest film and CT of a caverna in the apical segment of RUL (K). The draining bronchus is visible (arrow). CT (2 mm slice thickness) shows discrete air bronchograms in the consolidated area. Notice the haze around the consolidation as sign of exudation.
Ghon's complex (or Ghon lesion) with some central and peripheral lung lesions without enlarged lymphnodes of the hilum. The owner of this image interdicts the reproduction of his work on other websites. As long as he doesn`t ask for money you may visit his site however: http://www-medlib.med.utah.edu/WebPath/ORGAN.html
Multiple tuberculous granulomas. The owner of this image interdicts the reproduction of his work on other websites. As long as he doesn`t ask for money you may visit his site however: http://www-medlib.med.utah.edu/WebPath/ORGAN.html
The primary complex is formed by the tubercle in the periphery and the enlarged corresponding lymphnodes, which in this example show calcifications.
In the fibrous scar of a Ghon lesion a bronchial carcinoma may develop, as seen in this case.
Ghon lesion (tubercle, tuberculous granuloma) in left middle field.
Gross pathologic specimen with big tuberculoma that contains yellow "caseous" necrosis.
Enhancement over 20 HU is not a reliable sign of malignancy. This enhancing lesion was a tuberculous granuloma.
Extensive pleural effusion: pleuritis exsudativa tuberculosa
In the course of renal TB fibrous destruction of left calyces and pyelon. In the intravenous pyelogram (IVP) there is gross dilatation of calyces (hydrocalicosis). This finding is rarely and indication for IVP nowadays as it can be visualized with ultrasonography.
Tuberculous spondylitis (Pott disease). Narrowing of vertebral interspace. Typical destruction of adjacent vertebral bodies due to neighboring vertebral endplates.
Tuberculous spondylitis of lower thoracic spine. Sagittal MRI of thoracic spine, CT of 8. thoracic vertebral body. The t2 weighted MRI shows signal enhancement in TH 8-10. There is a ventral soft tissue enhancement. There is a left ventral destruction of TH8 in CT. The dorsal part of TH10 towards the spinal canal is destructed. Inflammatory material bulges into the spinal canal. This is better visualized then in CT (see next image, C)
Tuberculous spondylitis, same patient as above. CT scans of thoracic spine. A: TH1; B: TH8; C: TH10; D: os sacrum. Except of the lesion in TH10, destructions were not recognized in conventional spinal films.
Tuberculous spondylitis, very subtle initial manifestation. There is only a slight narrowing of the intervertebral space and some haziness of the endplates compared to the others. Only 14 days later vertebral bodies have patially collapsed.
Tuberculous abscess in right lobe of liver.
Tuberculous abscess in right lateral abdominal wall with bony destruction of iliac crest (tuberculous osteomyelitis
Intrabronchial dissimination in acute illness and after therapy: if a tuberculous lesion erodes a bronchus, the infectious material will be coughed up (risc of infection!) or re-aspirated. The latter case produces small alveolar densities. They are bigger and not so well defined as interstitial noduli of miliary tuberculosis.
Intrabronchial dissemination (a) by perforation of a tuberculous lymphnode into a bronchus. CT shows diffusely spread small ill-defined densities.
Intrabronchial dissemination (b). The chest film visualizes the small alveolar densities as well.
Miliary pulmonary tuberculosis. Gross macropathologic specimen. The owner of this image interdicts the reproduction of his work on other websites. As long as he doesn`t ask for money you may visit his site however: http://www-medlib.med.utah.edu/WebPath/ORGAN.html
Newborn with miliary TB (mother had active TB).
Exudative form of TB with simultaneous big cavity and fibrous changes.
Healed bilateral TB with extensive fibrous deformation. The hila are pulled cranially and hardly discernable. A fibrous strand pulls the right diaphragm upwards to the dense destroyed upper lobe. The left lung is overinflated with rounded lateral sinus. This is not caused by fluid accumulation but by the depressed diaphragm. CT scans of upper and lower parts of the thorax show the destruction of both upper lobes with cysts and bullae. There is an area of groundglass density at the base of tha right lung. This is caused by fibrosis.
Atypical TB (MAI = Mycobacterium avium intracellulare; MAC = Mycobacterium avium complex). Two months' follow up of therapy: only marginal regression of consolidations. Localization in mid field of lungs would suggest primary pulmonary tuberculosis. There are no cavities (impaired immune reaction?). On the left there is a characteristic pleural thickening.
CT shows ill-defined small nodules adjacent to the peripheral bronchovascular structures. This pattern is called "tree in bud". It is frequently found in atypical pulmonary tuberculosis.
(no consultations)
21.04.2007