Faces of TB Reactivation or Active

Active

  • Cavitation:
    • result from
      • necrosis and liquefaction of
      • lung parenchyma.
  • Consolidation:
    • dense, homogeneous opacities
    • reflecting the accumulation of inflammatory cells, bacteria, and cellular debris,
  • Miliary TB:
    • disseminates through the bloodstream,
  • Tree-in-Bud Appearance:
  • associated with bronchogenic spread of infection and may be seen in active TB.
  • Pleural Effusion:

Consolidation

Necrotizing Pneumonia Left Upper Lobe
38-year-old male with HIV

CT –TB Necrotizing Pneumonia Left Upper Lobe
38-year-old male with HIV presents with cough CT scan in the coronal plane shows a focal consolidation in the left upper lobe.
Lab tests confirmed a diagnosis of TB
Ashley Davidoff MD TheCommonVein.net 256Lu 136093c
CT –TB Necrotizing Pneumonia Left Upper Lobe
38-year-old male with HIV presents with cough CT scan in the axial plane shows a focal necrotizing consolidation in the left upper lobe.
Lab tests confirmed a diagnosis of TB
Ashley Davidoff MD TheCommonVein.net 256Lu 136098
CT –TB Necrotizing Pneumonia Left Upper Lobe
38-year-old male with HIV presents with cough CT scan in the axial plane shows a focal necrotizing consolidation in the left upper lobe. Regional lymphadenopathy in the mediastinum is noted
Lab tests confirmed a diagnosis of TB
Ashley Davidoff MD TheCommonVein.net 256Lu 136099
CT –TB Necrotizing Pneumonia Left Upper Lobe
38-year-old male with HIV presents with cough CT scan in the axial plane shows a focal necrotizing consolidation in the left upper lobe. Reginal lymphadenopathy in the mediastinum is noted
Lab tests confirmed a diagnosis of TB
Ashley Davidoff MD TheCommonVein.net 256Lu 136104

28-year-old immigrant with cough
CXR – Reactivation TB Cavitating Pneumonia – Left Upper Lobe

CXR – Reactivation TB Cavitating Pneumonia – Left Upper Lobe
Frontal CXR of a 28-year-old immigrant with cough shows a cavitating pneumonia in the left upper lobe (magnified in the lower image)
Lab tests confirmed the diagnosis of TB and the patient was treated with RISE a 4-month treatment regimen of rifapentine-moxifloxacin for mycobacterium tuberculosis.
Ashley Davidoff MD TheCommonVein.net 255Lu 136071c
CXR –TB Pneumonia – Left Upper Lobe

Consolidation Cavitation and Endobronchial Spread

CT –Reactivation TB – Left Upper Lobe
CT scan in the axial plane of the left upper lobe of a 28-year-old immigrant with cough shows a focal subsegmental consolidation with focal cavitation (yellow arrowhead) subtended by a thick-walled subsegmental airway. There are extensive tree in bud changes ringed in white (b and c) indicating transbronchial spread. Lab tests confirmed a diagnosis of TB and the patient was treated with RISE, a 4-month treatment regimen of rifapentine-moxifloxacin for mycobacterium tuberculosis.
Ashley Davidoff MD TheCommonVein.net 255Lu 136075cL

 

 

Focal Infiltrate

LUL Infiltrate14 months prior

30M lung liver lymph nodes spleen TB 005 CT lung nodule 1 year ago
LUL Nodule
Ashley Davidoff MD TheCommonVein.net

LUL Infiltrate 2 Months Later

30M lung liver lymph nodes spleen TB CT lung consolidation 1 year ago
Ashley Davidoff MD TheCommonVein.net

LUL Infiltrate 1 Month Later Following Initiation of Treatment 

30M lung liver lymph nodes spleen TB CT lung consolidation decreased but cavitated 11 months ago
Ashley Davidoff MD TheCommonVein.net

TB presenting as a Right Upper Lobe Infiltrate
Pre Treatment

Unusual case of TB presenting as a bronchovascular infiltrate with extension into the small airways in the Right Upper Lobe
Ashley Davidoff TheCommonVein.net
Unusual case of TB presenting as a bronchovascular infiltrate with extension into the small airways in the Right Upper Lobe
Ashley Davidoff TheCommonVein.net
Unusual case of TB presenting as a bronchovascular infiltrate with extension into the small airways in the Right Upper Lobe
Ashley Davidoff TheCommonVein.net
Unusual case of TB presenting as a bronchovascular infiltrate with extension into the small airways in the Right Upper Lobe with Tree in Bud Changes
Ashley Davidoff TheCommonVein.net
Unusual case of TB presenting as a bronchovascular infiltrate with extension into the small airways in the Right Upper Lobe with Tree in Bud Changes
Ashley Davidoff TheCommonVein.net

Post Treatment

Unusual case of TB presenting as a bronchovascular infiltrate with extension into the small airways in the Right Upper Lobe with Tree in Bud Changes
Ashley Davidoff TheCommonVein.net
Unusual case of TB presenting as a bronchovascular infiltrate with extension into the small airways in the Right Upper Lobe with Tree in Bud Changes
Ashley Davidoff TheCommonVein.net
Unusual case of TB presenting as a bronchovascular infiltrate with extension into the small airways in the Right Upper Lobe with Tree in Bud Changes
Ashley Davidoff TheCommonVein.net

 

 

Endobronchial Spread

CT –Reactivation TB – Left Upper Lobe Airway Disease Segmental Subsegmental and Small Airway Involvement
CT scan in the coronal plane of the left upper lobe of a 28-year-old immigrant with cough shows a thickening of the walls of the segmental, (blue circle) and subsegmental airway disease (teal circle ) as well as small airways disease characterised by tree in bud changes (ringed in whit)e These findings indicate transbronchial spread.
Lab tests confirmed a diagnosis of TB and the patient was treated with RISE, a 4-month treatment regimen of rifapentine-moxifloxacin for mycobacterium tuberculosis.
Ashley Davidoff MD TheCommonVein.net 255Lu 136079cL

Cavitation

CT –Reactivation TB – Left Upper Lobe Cavitation
CT scan in the axial plane of the left upper lobe of a 28-year-old immigrant with cough shows a thick walled cavitating mass subtended by a subsegmental thick-walled airway. Lab tests confirmed the diagnosis of TB and the patient was treated with RISE, a 4-month treatment regimen of rifapentine-moxifloxacin for mycobacterium tuberculosis.
Ashley Davidoff MD TheCommonVein.net 255Lu 136074c
CT –Reactivation TB – Cavitating Infiltrate Left Upper Lobe Connecting with Airways
CT scan in the coronal plane of the left upper lobe of a 28-year-old immigrant with cough shows a thick walled cavitating mass subtended by a subsegmental thick-walled airway. Lab tests confirmed the diagnosis of TB and the patient was treated with RISE, a 4-month treatment regimen of rifapentine-moxifloxacin for mycobacterium tuberculosis.
Ashley Davidoff MD TheCommonVein.net 255Lu 136081c
CT –Reactivation TB – Cavitating Infiltrate Left Upper Lobe Connecting with Airways
CT scan in the coronal plane of the left upper lobe of a 28-year-old immigrant with cough shows a thick walled cavitating mass subtended by a subsegmental thick-walled airway. Lab tests confirmed the diagnosis of TB and the patient was treated with RISE, a 4-month treatment regimen of rifapentine-moxifloxacin for mycobacterium tuberculosis.
Ashley Davidoff MD TheCommonVein.net 255Lu 136081c

Transbronchial Spread
eft Upper Lobe Airway Disease Segmental Subsegmental and Small Airway Involvement

CT –Reactivation TB – Left Upper Lobe Airway Disease Segmental Subsegmental and Small Airway Involvement
CT scan in the coronal plane of the left upper lobe of a 28-year-old immigrant with cough shows a thickening of the walls of the segmental, (blue circle) and subsegmental airway disease (teal circle ) as well as small airways disease characterised by tree in bud changes (ringed in whit)e These findings indicate transbronchial spread.
Lab tests confirmed a diagnosis of TB and the patient was treated with RISE, a 4-month treatment regimen of rifapentine-moxifloxacin for mycobacterium tuberculosis.
Ashley Davidoff MD TheCommonVein.net 255Lu 136079cL
CT –Reactivation TB – Left Upper Lobe
CT scan in the axial plane of the left upper lobe of a 28-year-old immigrant with cough shows a focal subsegmental consolidation with focal cavitation (yellow arrowhead) subtended by a thick-walled subsegmental airway. There are extensive tree in bud changes ringed in white (b and c) indicating transbronchial spread. Lab tests confirmed a diagnosis of TB and the patient was treated with RISE, a 4-month treatment regimen of rifapentine-moxifloxacin for mycobacterium tuberculosis.
Ashley Davidoff MD TheCommonVein.net 255Lu 136075cL

Miliary


Normal CXR and CT 1year   Prior

60 year old immunocompromise female 

CXR Normal CXR 7 Months Prior to Miliary Tuberculosis
Frontal CXR of a 60 year old immunocompromise female 1 year prior to an episode of miliary TB shows a normal CXR
Ashley Davidoff MD TheCommonVein.net 265Lu 136195
Normal CT 7 Months Prior to Miliary Tuberculosis
Axial CT of a 60-year-old immunocompromised female 1 year prior to an episode of miliary TB shows a normal examination
Ashley Davidoff MD TheCommonVein.net 265Lu 136196

60-year-old immunocompromise female presents with a
cough and weight loss

Frontal CXR – Miliary TB
60-year-old immunocompromise female presents with a cough and weight loss CXR shows a diffuse miliary pattern. Final diagnosis was mycobacterium tuberculosis. Associated findings include healed right sided rib fractures and surgical clips in the left axilla
Ashley Davidoff MD TheCommonVein.net 265Lu 136197
CT Miliary Tuberculosis
60-year-old female presents with a cough and weight loss. Coronal CT shows miliary nodules throughout both lung fields. The nodules appear to be distributed along the bronchovascular bundles and the lymphatics and are noted in centrilobular, fissural and pleural locations. She responded well to treatment and final diagnosis was mycobacterium tuberculosis.
Ashley Davidoff MD TheCommonVein.net 265Lu 136206

CT Miliary Tuberculosis Centrilobular Nodules Suggesting Arteriolar Small Airway and or Lymphatic Involvement Also Fissural Nodules and Pleural Nodules

CT Miliary Tuberculosis Centrilobular Nodules Suggesting Arteriolar Small Airway and or Lymphatic Involvement Also Fissural Nodules and Pleural Nodules
60-year-old immunocompromised female presents with a cough and weight loss. Axial CT shows miliary nodules throughout both lung fields. Some of these nodules are centrilobular (c, maroon arrowheads) and others are fissural based (b, pink arrowheads). In some of the secondary lobules there are 2 centrilobular nodules indicating involvement of the airway and arteriole and or the lymphatics (c white rings). One lobule shows centrilobular and interlobular nodules (c gray ring anteriorly). She responded well to treatment and final diagnosis was mycobacterium tuberculosis.
Ashley Davidoff MD TheCommonVein.net 265Lu 136204cL

Pleural Effusion

ACTIVE TB – Reactivation PLEURAL EFFUSIONS
80 year old Russian woman who initially presented with a cavitating LUL nodule that was biopsied and thought to represent sarcoidosis
In December the nodules in the LUL enlarged with an arborising pattern involving the posterior subsegment of the LUL as well as an unchanged RUL ground glass infiltrate
Subsequent diagnosis of TB was made
Initially there was progressive disease in the LUL and lingula with new cavitation in the lingula infiltrate/nodule and extension of the infiltrate in the LUL with a new calcification. These findings were consistent with reactivation TB .
Repeated sputa were positive for acid fast bacilli
More recently new micronodularity was noted in the right lung .
Now 1 month later she presents with a large right pleural effusion and a smaller left effusion
Ashley Davidoff MD The Commonvein.net 31645L02b