CT Findings in Pulmonary

Tuberculosis
 Primary Tuberculosis
• CT helps confirm the presence of an ill-defined parenchymal
infiltrate, as well as lymphadenopathy.

• CT scans may demonstrate enlarged lymph nodes typically

measuring more than 2 cm. Lymph nodes demonstrate central
hypoattenuation with peripheral rim enhancement with the
administration of contrast material. This appearance reflects central
necrosis within the node.

• CT is the examination of choice for evaluating lymphadenopathy

and involvement of the tracheobronchial tree. Lymphadenopathy
causing bronchial compression can be identified on CT scans, and
airway compromise can be monitored during chemotherapy.
 Primary Tuberculosis
• Broncholiths may be identified in rare cases.
• Morphologically, the stenoses in active disease
are areas of irregular luminal narrowing with
circumferential wall thickening.
• Associated mediastinitis and even mediastinal
abscesses may be present.
• In patients who are severely affected,
segmentectomy or lobectomy may be required to
treat the symptoms.
 Primary Tuberculosis
• Small pleural effusions are detected more
readily on CT scans than on other images.
Contrast enhancement may be useful in
identifying evolution into an empyema.
 Reactivation Tuberculosis
• Cavitation is best demonstrated on CT scans.
• The outer wall of the cavity tends to be thick walled
and irregular, whereas the inner wall tends to be
smooth.
• An air-fluid level may be identified. The connection of
the cavity to the airway may be visualized.
• Complications of cavitary disease may become
apparent with mycetoma formation, which appears as
an intraluminal collection of material with a crescent of
surrounding air. Changes in patient positioning
demonstrate a change in the position of the mycetoma
relative to the cavity.
 Reactivation Tuberculosis
• Tuberculomas can be identified on CT scans as
rounded nodules that usually have
surrounding associated satellite lesions.
• The bronchogenic spread of tuberculosis is
recognized on CT scans by the presence of
acinar shadows and nodules of varying sizes in
a peribronchial distribution. The lesions are
seen throughout both lungs.
 Airway Involvement
• Lymphadenopathy is a feature of primary
infection; however, calcified lymph nodes may
cause persistent extrinsic compression on the
bronchi.
• Bronchial stenosis is more common in
postprimary disease than in primary tuberculosis.
In fibrocavitary tuberculosis, the proximal bronchi
are more typically involved than the peripheral
airways. Variable areas of stenosis are
demonstrated. Wall thickening tends to be less
marked than in primary tuberculosis.
 Airway Involvement
• Bronchiectasis is a well-known sequela of
postprimary disease. Bronchiectasis tends to
occur in the upper lobes and often manifests
as traction bronchiectasis on the basis of
fibrotic disease with subsequent traction on
the airways. Recurrent infections and
hemoptysis may result from traction
bronchiectasis.
 Pleural Involvement
• Empyema is visualized on contrast-enhanced CT scans
with enhancement of the parietal and visceral pleurae.
• They may demonstrate enhancing septa within the
pleural fluid collections. The pleural fluid collections
are characterized by low attenuation; however, they do
not have attenuation values consistent with simple
fluid.
• Empyemas demonstrate the so-called split pleura sign.
This sign consists of the pleural fluid collection tracking
between the abnormally enhancing parietal and
visceral pleura.
 Pleural Involvement
• Spontaneous pneumothorax is an uncommon
complication of disease, may be secondary to
peripherally located lesions.
• Involvement of the pericardium and spine may
be demonstrated on CT images.