X-ray of the thorax in tuberculosis - Revision history

Mikael Häggström: Choice

2019-05-06T10:58:21Z

Choice

Mikael Häggström: CC-BY images

2019-01-21T12:09:32Z

CC-BY images

Mikael Häggström: /* Chest X-ray findings that can suggest inactive TB */ br

2019-01-21T10:04:45Z

Chest X-ray findings that can suggest inactive TB: br

Mikael Häggström: /* Evaluation */ Bolded

2019-01-21T10:03:23Z

Evaluation: Bolded

Mikael Häggström: /* Chest X-ray findings that can suggest active TB */ Explained

2019-01-21T09:33:42Z

Chest X-ray findings that can suggest active TB: Explained

Mikael Häggström: /* Chest X-ray findings that can suggest active TB */ Not that relevant to radiologist

2019-01-21T09:32:12Z

Chest X-ray findings that can suggest active TB: Not that relevant to radiologist

Mikael Häggström at 08:48, 26 September 2018

2018-09-26T08:48:38Z

Mikael Häggström: Explained

2018-08-02T08:40:19Z

Explained

Mikael Häggström: ]

2018-08-02T08:39:46Z

]

Mikael Häggström: Introduced

2018-08-02T08:39:26Z

Introduced

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 ;Indications
 Symptoms and/or previous stay in geographic area with high prevalence of tuberculosis.
+{{Pulmonary tuberculosis - Choice of investigation}}
 ;Projections
 A posterior-anterior (PA) is the standard view used; other views (lateral or lordotic) or CT scans may be necessary.

@@ Line 54: / Line 54: @@
 . '''Miliary nodules ''' - nodules of millet size (1 to 2 millimeters) distributed throughout the parenchyma.
 <gallery mode=packed heights=190>
-File:PulmonaryTBCXR.png|[[Miliary tuberculosis]]
+File:Chest radiograph of miliary tuberculosis 1.jpg|Miliary tuberculosis, 13 days after onset, showing bilateral interstitial infiltrates
 </gallery>

@@ Line 61: / Line 61: @@
 The main chest X-ray findings that can suggest inactive TB are:<ref name=cdc/>
-. '''Discrete fibrotic scar or linear opacity''' — Discrete linear or reticular densities within the lung. The edges of these densities should be distinct and there should be no suggestion of airspace opacification or haziness between or surrounding these densities. Calcification can be present within the lesion and then the lesion is called a “fibrocalcific” scar.
+<br>1. '''Discrete fibrotic scar or linear opacity''' — Discrete linear or reticular densities within the lung. The edges of these densities should be distinct and there should be no suggestion of airspace opacification or haziness between or surrounding these densities. Calcification can be present within the lesion and then the lesion is called a “fibrocalcific” scar.
 <gallery mode=packed heights=190>
 File:Chest X-ray of fibrocalcific scar after secondary tuberculosis.jpg|Chest  x-ray  showing fibrocalcific scar after secondary tuberculosis as air-space opacification or  haziness between or surrounding these densities.

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 This category comprises all findings typically associated with active pulmonary TB.<ref name=cdc/>
-. Infiltrate or consolidation - Opacification of airspaces within the lung parenchyma. Consolidation or infiltrate can be dense or patchy and might have irregular, ill-defined, or hazy borders.
+. '''Infiltrate or consolidation''' - Opacification of airspaces within the lung parenchyma. Consolidation or infiltrate can be dense or patchy and might have irregular, ill-defined, or hazy borders.
 <gallery mode=packed heights=190>
 File:Dense opacity of primary pulmonary tuberculosis.jpg|Dense homogenous opacity in right, middle and lower lobe of primary pulmonary TB.
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 File:Chest x-ray of Ghon's complex of active tuberculosis.jpg|Chest x-ray of Ghon's complex of active tuberculosis. A Ghon's complex consists of a calcified focus of infection and an associated lymph node.
 </gallery>
-. Any cavitary lesion - Lucency (darkened area) within the lung parenchyma, with or without irregular margins that might be surrounded by an area of airspace consolidation or infiltrates, or by nodular or fibrotic (reticular) densities, or both. The walls surrounding the lucent area can be thick or thin. Calcification can exist around a cavity.
+. '''Any cavitary lesion''' - Lucency (darkened area) within the lung parenchyma, with or without irregular margins that might be surrounded by an area of airspace consolidation or infiltrates, or by nodular or fibrotic (reticular) densities, or both. The walls surrounding the lucent area can be thick or thin. Calcification can exist around a cavity.
 <gallery mode=packed heights=190>
 File:Tuberculosis-x-ray-1.jpg|Chest X-ray of a person with advanced tuberculosis: Infection in both lungs is marked by white arrow-heads, and the formation of a cavity is marked by black arrows.
 </gallery>
-. Nodule with poorly defined margins - Round density within the lung parenchyma, also called a tuberculoma. Nodules included in this category are those with margins that are indistinct or poorly defined ([[tree-in-bud sign]]<ref>{{cite journal|last=Rossi|first=S. E.|author2=Franquet, T. |author3=Volpacchio, M. |author4=Gimenez, A. |author5= Aguilar, G. |title=Tree-in-Bud Pattern at Thin-Section CT of the Lungs: Radiologic-Pathologic Overview|journal=Radiographics|date=1 May 2005|volume=25|issue=3|pages=789–801|doi=10.1148/rg.253045115|url=http://radiographics.rsna.org/content/25/3/789.full|accessdate=28 May 2012}}</ref>). The surrounding haziness can be either subtle or readily apparent and suggests coexisting airspace consolidation.
+. '''Nodule with poorly defined margins''' - Round density within the lung parenchyma, also called a tuberculoma. Nodules included in this category are those with margins that are indistinct or poorly defined ([[tree-in-bud sign]]<ref>{{cite journal|last=Rossi|first=S. E.|author2=Franquet, T. |author3=Volpacchio, M. |author4=Gimenez, A. |author5= Aguilar, G. |title=Tree-in-Bud Pattern at Thin-Section CT of the Lungs: Radiologic-Pathologic Overview|journal=Radiographics|date=1 May 2005|volume=25|issue=3|pages=789–801|doi=10.1148/rg.253045115|url=http://radiographics.rsna.org/content/25/3/789.full|accessdate=28 May 2012}}</ref>). The surrounding haziness can be either subtle or readily apparent and suggests coexisting airspace consolidation.
 <gallery mode=packed heights=190>
 File:Chest X-ray and CT of tree-in-bud sign post-primary pulmonary tuberculosis.jpg|Chest x-ray showing nodule with margins that are indistinct or poorly defined (tree-in-bud sign) in post-primary pulmonary TB.
 </gallery>
-<br>4. Pleural effusion - Presence of a significant amount of fluid within the pleural space. This finding must be distinguished from blunting of the costophrenic angle, which may or may not represent a small amount of fluid within the pleural space (except in children when even minor blunting must be considered a finding that can suggest active TB).
+. '''Pleural effusion''' - Presence of a significant amount of fluid within the pleural space. This finding must be distinguished from blunting of the costophrenic angle, which may or may not represent a small amount of fluid within the pleural space (except in children when even minor blunting must be considered a finding that can suggest active TB).
 <gallery mode=packed heights=190>>
 File:Pleural effusion of primary pulmonary tuberculosis.jpg|Chest x-ray showing dense opacity pleural effusion in the lower left lung of primary pulmonary TB.
 </gallery>
-. Hilar or mediastinal lymphadenopathy ([[bihilar lymphadenopathy]]) - Enlargement of lymph nodes in one or both hila or within the mediastinum, with or without associated atelectasis or consolidation.
+. '''Hilar or mediastinal lymphadenopathy''' ([[bihilar lymphadenopathy]]) - Enlargement of lymph nodes in one or both hila or within the mediastinum, with or without associated atelectasis or consolidation.
 <gallery mode=packed heights=190>>
 File:Chest x-ray of bilateral hilar adenopathy of primary pulmonary tuberculosis.jpg|Chest x-ray showing bilateral hilar adenopathy of primary pulmonary TB
 </gallery>
-. Linear, interstitial disease (in children only) - Prominence of linear, interstitial (septal) markings.
+. '''Linear, interstitial disease''' (in children only) - Prominence of linear, interstitial (septal) markings.
 <gallery mode=packed heights=190>>
 File:Kerley B lines of primary tuberculosis.jpg|Chest x-ray showing Kerely B line due to interstitial oedema (in children only) of primary pulmonary tuberculosis.
 </gallery>
-. Other - Any other finding suggestive of active TB, such as miliary TB. Miliary findings are nodules of millet size (1 to 2 millimeters) distributed throughout the parenchyma.
+. '''Miliary nodules ''' - nodules of millet size (1 to 2 millimeters) distributed throughout the parenchyma.
 <gallery mode=packed heights=190>
 File:PulmonaryTBCXR.png|[[Miliary tuberculosis]]
@@ Line 61: / Line 61: @@
 The main chest X-ray findings that can suggest inactive TB are:<ref name=cdc/>
-. Discrete fibrotic scar or linear opacity—Discrete linear or reticular densities within the lung. The edges of these densities should be distinct and there should be no suggestion of airspace opacification or haziness between or surrounding these densities. Calcification can be present within the lesion and then the lesion is called a “fibrocalcific” scar.
+. '''Discrete fibrotic scar or linear opacity''' — Discrete linear or reticular densities within the lung. The edges of these densities should be distinct and there should be no suggestion of airspace opacification or haziness between or surrounding these densities. Calcification can be present within the lesion and then the lesion is called a “fibrocalcific” scar.
 <gallery mode=packed heights=190>
 File:Chest X-ray of fibrocalcific scar after secondary tuberculosis.jpg|Chest  x-ray  showing fibrocalcific scar after secondary tuberculosis as air-space opacification or  haziness between or surrounding these densities.
 </gallery>
-. Discrete nodule(s) without calcification—One or more nodular densities with distinct borders and without any surrounding airspace opacification. Nodules are generally round or have rounded edges. These features allow them to be distinguished from infiltrates or airspace opacities. To be included here, these nodules must be noncalcified. Nodules that are calcified are included in the category “OTHER X-ray findings, No follow-up needed”.
+. '''Discrete nodule(s) without calcification'''  - One or more nodular densities with distinct borders and without any surrounding airspace opacification. Nodules are generally round or have rounded edges. These features allow them to be distinguished from infiltrates or airspace opacities. To be included here, these nodules must be noncalcified. Nodules that are calcified are included in the category “OTHER X-ray findings, No follow-up needed”.
 <gallery mode=packed heights=190>
 File:Chest X-ray of discrete round nodules after secondary tuberculosis.jpg|Chest x-ray showing discrete round nodule(s) with round edges without calcification, after secondary tuberculosis.
 </gallery>
-. Discrete fibrotic scar with volume loss or retraction—Discrete linear densities with reduction in the space occupied by the upper lobe. Associated signs include upward deviation of the fissure or hilum on the corresponding side with asymmetry of the volumes of the two thoracic cavities.
+. '''Discrete fibrotic scar with volume loss or retraction''' — Discrete linear densities with reduction in the space occupied by the upper lobe. Associated signs include upward deviation of the fissure or hilum on the corresponding side with asymmetry of the volumes of the two thoracic cavities.
 <gallery mode=packed heights=190>
 File:Chest x-ray of distinct fibrotic scar after secondary tuberculosis.jpg|Chest x-ray showing  distinct fibrotic  scar  with volume loss or  retraction  with  an  upward  deviation  of  the fissure or hilum on the corresponding side with asymmetry of the volumes of the two thoracic cavities.
 </gallery>
-. Discrete nodule(s) with volume loss or retraction—One or more nodular densities with distinct borders and no surrounding airspace opacification with reduction in the space occupied by the upper lobe. Nodules are generally round or have rounded edges.
+. '''Discrete nodule(s) with volume loss or retraction''' — One or more nodular densities with distinct borders and no surrounding airspace opacification with reduction in the space occupied by the upper lobe. Nodules are generally round or have rounded edges.
 <gallery mode=packed heights=190>
 File:Chest x-ray of discrete nodule and volume loss.jpg|Chest x-ray showing nodular densities with distinct borders and no surrounding airspace  opacification, with a reduction in the space occupied by the upper lobe.
 </gallery>
-. Other—Any other finding suggestive of prior TB, such as upper lobe bronchiectasis. Bronchiectasis is bronchial dilation with bronchial wall thickening.
+. '''Upper lobe bronchiectasis''' - Bronchial dilation with bronchial wall thickening.
 <gallery mode=packed heights=190>
 File:Chest x-ray of bronchiectasis post-primary pulmonary tuberculosis.jpg|Chest x-ray showing course bronchiectasis of the lungs post-primary pulmonary tuberculosis.

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 File:Chest X-ray of patchy opacities of pulmonary tuberculosis.jpg|Chest x-ray showing patchy opacification on the upper right and mid-zone lung with fibrotic  shadows, as well as bilateral hilar lymphadenopathy.
 File:Chest X-ray reticulonodular densities post-primary pulmonary tuberculosis.jpg|Chest x-ray showing coarse reticulonodular densities on the lower right lung of post-primary pulmonary TB.
-File:Chest x-ray of Ghon's complex of active tuberculosis.jpg|Chest x-ray of [[Ghon's complex]] of active tuberculosis
+File:Chest x-ray of Ghon's complex of active tuberculosis.jpg|Chest x-ray of Ghon's complex of active tuberculosis. A Ghon's complex consists of a calcified focus of infection and an associated lymph node.
 </gallery>
 . Any cavitary lesion - Lucency (darkened area) within the lung parenchyma, with or without irregular margins that might be surrounded by an area of airspace consolidation or infiltrates, or by nodular or fibrotic (reticular) densities, or both. The walls surrounding the lucent area can be thick or thin. Calcification can exist around a cavity.

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 ===Abnormal findings===
 ====Chest X-ray findings that can suggest active TB====
-This category comprises all findings typically associated with active pulmonary TB.<ref name=cdc/> In the US, refugees or immigration applicants with any of the following findings must submit sputum specimens for examination.<ref name=cdc/>
+This category comprises all findings typically associated with active pulmonary TB.<ref name=cdc/>
 . Infiltrate or consolidation - Opacification of airspaces within the lung parenchyma. Consolidation or infiltrate can be dense or patchy and might have irregular, ill-defined, or hazy borders.

@@ Line 1: / Line 1: @@
-{{Authors
+{{Top
 |author1=[[User:Mikael Häggström|Mikael Häggström]]
 |author2=
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 #Minor cardiac findings - Minor findings needing no follow-up.
-==References==
+{{Bottom}}

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 [[Image:TB CXR.jpg|thumb|Tuberculosis creates cavities visible in [[x-ray]]s like this one in the patient's right upper lobe.]]
-'''[[X-ray of the thorax]]''' in suspected tuberculosis:
+'''[[X-ray of the thorax|Projectional radiography ("X-ray") of the thorax]]''' in suspected tuberculosis:
 ==Planning==