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Test

Parenchymal lesions

  • Tuberculoma
  • Single or multiple lesions of > 0.5 cm
  • May occur in primary or secundary TB
  • Main finding on Chest X-ray in 5% cases of secondary TB[1]
  • Results from the surrounding of M. tuberculosis with inflammatory or connective tissue.[2][3][1]
  • The center of the tuberculoma is often necrotic
  • Satellite lesions (80%)
  • Nodular or diffused calcifications in 20-30% cases[2]
  • Thin-walled cavity
  • Present in active and inactive disease
  • May regress after treatment
  • Air-filled sect may persist[4]
  • May be misidentified as an emphysematous bulla or pneumatocelle.
  • Cicatrization:
  • Common in secondary TB
  • Marked fibrosis in ≤40% of secondary TB cases, which may present as:
  • Upper love atelectasis
  • Compensatory hyperinflation of the lower lobe
  • Hilar retraction
  • Mediastinal shift
  • Unspecific X-Ray findings:[5]
  • Parenchymal bands
  • Fibrotic cavities
  • Fibrotic nodules
  • Traction bronchiectasis
  • Lung Destruction:[5]
  • Common in end-stage of TB
  • Involvement of the airways and parenchyma
  • May follow primary TB or secondary TB
  • Spreads across the lung with cavitation and fibrosis[2]
  • Concomitant infection with bacteria or bacteria may occur
  • Complicates assessment of TB activity in the lung with the X-ray.
  • Mass of hyphae, cell debris and mucus, commonly located in a cavity or bronchus[6][7][8]
  • Previous history of chronic cavitary TB in 25-55% of cases presenting with aspergilloma
  • Frequently courses with hemoptysis (50-90%)
  • X-ray shows a mobile mass ringed by an air shadow
  • CT shows a mobile mass, generally interspaced with air shadows
  • May be calcified
  • Bronchogenic carcinoma[5]
  • May be misinterpreted as TB progression
  • Scar formation in TB may lead to carcinoma
  • May cause reactivation of TB[9][10]

Airway Lesions

Differential Diagnosis of Infectious Diarrhea

Acute inflammatory diarrhea may be caused by different pathogens. Bellow is a table describing some of these pathogens in terms of transmission and symptoms:[11][12]

Pathogen Transmission Clinical Manifestations
Fever Nausea/Vomiting Abdominal Pain Bloody Stool
Salmonella Foodborne transmission, community-acquired ++ + ++ +
Shigella Community-acquired, person-to-person ++ ++ ++ +
Campylobacter Community-acquired, ingestion of undercooked poultry ++ + ++ +
E. coli (EHEC or EIEC) Foodborne transmission, ingestion of undercooked hamburger meat ± + ++ ++
Clostridium difficile Nosocomial spread, antibiotic use + ± + +
Yersinia Community-aquired, foodborne transmission ++ + ++ +
Entamoeba histolytica Travel to or emigration from tropical regions + ± + ±
Aeromonas Ingestion of contaminated water ++ + ++ +
Plesiomonas Ingestion of contaminated water or undercooked shellfish, travel to tropical regions ± ++ + +

References

  1. ↑ 1.0 1.1 Woodring JH, Vandiviere HM, Fried AM, Dillon ML, Williams TD, Melvin IG (1986). "Update: the radiographic features of pulmonary tuberculosis". AJR Am J Roentgenol. 146 (3): 497–506. doi:10.2214/ajr.146.3.497. PMID 3484866.
  2. ↑ 2.0 2.1 2.2 Lee KS, Song KS, Lim TH, Kim PN, Kim IY, Lee BH (1993). "Adult-onset pulmonary tuberculosis: findings on chest radiographs and CT scans". AJR Am J Roentgenol. 160 (4): 753–8. doi:10.2214/ajr.160.4.8456658. PMID 8456658.
  3. ↑ Palmer PE (1979). "Pulmonary tuberculosis--usual and unusual radiographic presentations". Semin Roentgenol. 14 (3): 204–43. PMID 472765.
  4. ↑ Fraser, Richard (1994). Synopsis of diseases of the chest. Philadelphia: W.B. Saunders. ISBN 0721636691.
  5. ↑ 5.0 5.1 5.2 Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH (2001). "Thoracic sequelae and complications of tuberculosis". Radiographics. 21 (4): 839–58, discussion 859-60. doi:10.1148/radiographics.21.4.g01jl06839. PMID 11452057.
  6. ↑ Logan PM, Müller NL (1996). "CT manifestations of pulmonary aspergillosis". Crit Rev Diagn Imaging. 37 (1): 1–37. PMID 8744521.
  7. ↑ Miller WT (1996). "Aspergillosis: a disease with many faces". Semin Roentgenol. 31 (1): 52–66. PMID 8838945.
  8. ↑ Thompson BH, Stanford W, Galvin JR, Kurihara Y (1995). "Varied radiologic appearances of pulmonary aspergillosis". Radiographics. 15 (6): 1273–84. doi:10.1148/radiographics.15.6.8577955. PMID 8577955.
  9. ↑ Snider GL, Placik B (1969). "The relationship between pulmonary tuberculosis and bronchogenic carcinoma. A topographic study". Am Rev Respir Dis. 99 (2): 229–36. PMID 4975011.
  10. ↑ Ting YM, Church WR, Ravikrishnan KP (1976). "Lung carcinoma superimposed on pulmonary tuberculosis". Radiology. 119 (2): 307–12. doi:10.1148/119.2.307. PMID 1265261.
  11. ↑ Thielman NM, Guerrant RL (2004). "Clinical practice. Acute infectious diarrhea". N Engl J Med. 350 (1): 38–47. doi:10.1056/NEJMcp031534. PMID 14702426.
  12. ↑ Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA (2004). "Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study". J Trop Pediatr. 50 (6): 354–6. doi:10.1093/tropej/50.6.354. PMID 15537721.
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