Ji Young CHOO, Ki Yeol LEE, Bo Kyung JE, Seung Hwa LEE, Eun-young KANG, Yu Whan OH, Bo Kyung SEO, Mi-young KİM

Pulmonary Tuberculosis Confirmed by Percutaneous Transthoracic Needle Biopsy: Analysis of CT Findings and Review of Correlations with Underlying Lung Disease

Background: Pulmonary tuberculosis (TB) can produce unusual radiographic findings. Further, negative sputum and bronchoscopic results are common. Early diagnosis is equally as significant as treatment in the reduction of morbidity and mortality associated with pulmonary TB. Aims: The aim of this study was to assess computed tomography (CT) findings of pulmonary TB, confirmed via percutaneous transthoracic needle biopsy (PTNB), and to correlate these findings with coexisting, underlying, lung diseases if present. Study Design: Cross sectional study. Methods: We selected eighty-four patients who were diagnosed with pulmonary TB by way of PTNB. Initially, acid-fast bacilli smear test results from these patients were negative. CT findings were reviewed to detect the presence of parenchymal abnormalities as follows: nodule(s) (=3 cm), daughter nodules, air-space consolidation, cavitation, calcification, lymphadenopathy, mediastinal lymphadenopathy, and associated lung parenchymal disease. Results: The CT findings of pulmonary TB confirmed by PTNB included nodules in 44 of 84 (52.4%) cases; 15 of these 44 cases (34.1%) had daughter nodules. The second most common finding was masses in 24 cases (28.6%), nine of which also had daughter nodules. 16 cases (19.0%) displayed nonsegmental consolidation. Of these 16 cases, four had coexisting usual interstitial pneumonia; four others had emphysema. Two patients with a mass had underlying pneumoconiosis. Conclusion: Nodules or a mass mimicking lung cancer were the most common findings on CT scans in patients with pulmonary TB, confirmed via PTNB. The second most common finding was airspace consolidation. Therefore, PNTB is useful for the accurate diagnosis of pulmonary TB in the following cases: airspace consolidation or mass associated with underlying usual interstitial pneumonia, emphysema mimicking lung malignancy or cases of bacterial pneumonia.

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Andreu J, Cáceres J, Pallisa E, Martinez-Rodriguez M. Radiological manifestations of pulmonary tuberculosis. Eur J Radiol 2004;51:139- 49. [CrossRef]
Diagnostic Standards and Classification of Tuberculosis in Adults and Children. This official statement of the American Thoracic Society and the Centers for Disease Control and Prevention was adopted by the ATS Board of Directors, July 1999. This statement was endorsed by the Council of the Infectious Disease Society of America, September 1999. Am J Respir Crit Care Med 2000;161:1376-95. [CrossRef]
Jeong YJ, Lee KS. Pulmonary tuberculosis: up-to-date imaging and management. AJR Am J Roentgenol 2008;191:834-44. [CrossRef]
Narayana Reddy RA, Narayana SM, Shariff S. Role of fine-needle as- piration cytology and fluid cytology in extra-pulmonary tuberculosis. Diagn Cytopathol 2013;41:392-8. [CrossRef]
Shachor Y, Schindler D, Siegal A, Lieberman D, Mikulski Y, Bruderman I. Increased incidence of pulmonary tuberculosis in chronic interstitial lung disease. Thorax 1989;44:151-3. [CrossRef]
Hadlock FP, Park SK, Awe RJ, Rivera M. Unusual radiographic findings in adult pulmonary tuberculosis. AJR Am J Roentgenol 1980;134:1015-8. [CrossRef]
Miller WT, MacGregor RR. Tuberculosis: Frequency of unusual radio- graphic findings. AJR Am J Roentgenol 1978;130:867-75. [CrossRef]
Lee KS, Song KS, Lim TH, Kim PN, Kim IY, Lee BH. Adult-onset pul- monary tuberculosis: findings on chest radiographs and CT scans. AJR Am J Roentgenol 1993;160:753-8. [CrossRef]
Palmer PE. Pulmonary tuberculosis-usual and unusual radiographic pre- sentations. Semin Roentgenol 1979;14:204-43. [CrossRef]
Van Dyck P, Vanhoenacker FM, Van den Brande P, De Schepper AM. Imaging of pulmonary tuberculosis. Eur Radiol 2003;13:1771-85. [CrossRef]
Ikezoe J, Takeuchi N, Johkoh T, Kohno N, Tomiyama N, Kozuka T, et al. CT appearance of pulmonary tuberculosis in diabetic and immuno- compromised patients: comparison with patients who had no underlying disease. AJR Am J Roentgenol 1992;159:1175-9. [CrossRef]
Morris JT, Seaworth BJ, McAllister CK. Pulmonary tuberculosis in dia- betics. Chest 1992;102:539-41. [CrossRef]
Jones BE, Ryu R, Yang Z, Cave MD, Pogoda JM, Otaya M, et al. Chest radiographic findings in patients with tuberculosis with recent or remote infection. Am J Respir Crit Care Med 1997;156:1270-3. [CrossRef]
Geng E, Kreiswirth B, Burzynski J, Schluger NW. Clinical and radio- graphic correlates of primary and reactivation tuberculosis: a molecular epidemiology study. JAMA 2005;293:2740-5. [CrossRef]
Ferreirós J, Bustos A, Merino S, Castro E, Dorao M, Crespo C. Trans- thoracic needle aspiration biopsy: value in the diagnosis of mycobacte- rial lung opacities. J Thorac Imaging 1999;14:194-200. [CrossRef]
Zwirewich CV, Vedal S, Miller RR, Müller NL. Solitary pulmonary nod- ule: high-resolution CT and radiologic-pathologic correlation. Radiol- ogy 1991;179:469-76. [CrossRef]
Murayama S, Murakami J, Hashimoto S, Torii Y, Masuda K. Noncalci- fied pulmonary tuberculomas: CT enhancement patterns with histologi- cal correlation. J Thorac Imaging 1995;10:91-5. [CrossRef]
Thiessen R, Seely JM, Matzinger FR, Agarwal P, Burns KL, Dennie CJ, et al. Necrotizing granuloma of the lung: imaging characteristics and imaging-guided diagnosis. AJR Am J Roentgenol 2007;189:1397- 401. [CrossRef]
Li Y, Su M, Li F, Kuang A, Tian R. The value of (1)(8)F-FDG-PET/CT in the differential diagnosis of solitary pulmonary nodules in areas with a high incidence of tuberculosis. Ann Nucl Med 2011;25:804-11. [CrossRef]
Zhuang H, Alavi A. 18-fluorodeoxyglucose positron emission tomo- graphic imaging in the detection and monitoring of infection and inflam- mation. Semin Nucl Med 2002;32:47-59. [CrossRef]
Rosenbaum SJ, Lind T, Antoch G, Bockisch A. False-positive FDG PET uptake-the role of PET/CT. Eur Radiol 2006;16:1054-65. [CrossRef]
Yoon JY, Lee IJ, Im HJ, Lee K, Lee Y, Bae SH. CT findings in apical ver- sus basal involvement of pulmonary tuberculosis. Diagn Interv Radiol 2013;19:85-90.
Cowie RL. The epidemiology of tuberculosis in gold miners with silico- sis. Am J Respir Crit Care Med 1994;150:1460-2. [CrossRef]
Chakrabarti B, Calverley PM, Davies PD. Tuberculosis and its inci- dence, special nature, and relationship with chronic obstructive pulmo- nary disease. Int J Chron Obstruct Pulmon Dis 2007;2:263-72.
Chung MJ, Goo JM, Im JG. Pulmonary tuberculosis in patients with idiopathic pulmonary fibrosis. Eur J Radiol 2004;52:175-9. [CrossRef]
Park SW, Song JW, Shim TS, Park MS, Lee HL, Uh ST, et al. My- cobacterial pulmonary infections in patients with idiopathic pulmonary fibrosis. J Korean Med Sci 2012;27:896-900. [CrossRef]
Silverman JF, Marrow HG. Fine needle aspiration cytology of granulo- matous diseases of the lung, including nontuberculous Mycobacterium infection. Acta Cytol 1985;29:535-41.
Yuan A, Yang PC, Chang DB, Yu CJ, Lee LN, Wu HD, et al. Ultrasound guided aspiration biopsy for pulmonary tuberculosis with unusual radio- graphic appearances. Thorax 1993;48:167-70. [CrossRef]