Tuberculosis from Head to Toe1
(CME available in print version and on RSNA Link)
Mukesh G. Harisinghani, MD ,
Theresa C. McLoud, MD,
Jo-Anne O. Shepard, MD,
Jane P. Ko, MD,
Manohar M. Shroff, MD and
Peter R. Mueller, MD
1 From the Department of Radiology, Ellison 234, Massachusetts General Hospital, Harvard Medical School, 32 Fruit St, Boston, MA 02114 (M.G.H., T.C.M., J.O.S., J.P.K., P.R.M.), and the Department of Radiology, P.D. Hinduja National Hospital, Mahim, Bombay, India (M.M.S.). Presented as a scientific exhibit at the 1998 RSNA scientific assembly. Received February 19, 1999; revision requested April 14 and received June 18; accepted June 21. Address reprint requests to M.G.H. (e-mail: mharisinghani@partners.org).
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Figure 1. Consolidation in primary tuberculosis. Frontal chest radiograph demonstrates consolidation in the right middle lobe (straight arrow) with right hilar adenopathy (curved arrow).
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Figure 2. Tuberculomas in primary tuberculosis. Frontal radiograph of the right lung demonstrates well-defined nodules (arrows), findings that are consistent with tuberculomas.
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Figure 3. Pulmonary parenchymal changes and lymphadenopathy in primary tuberculosis. Axial contrast material-enhanced computed tomographic (CT) scan demonstrates a parenchymal lung cavity in the lingula (solid white arrow) with enlarged necrotic subcarinal lymph nodes (black arrows). There is accompanying collapse of the left lower lobe (open arrow).
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Figure 4. Mediastinal tuberculous adenopathy. Axial contrast-enhanced CT scan demonstrates multiple enlarged mediastinal lymph nodes with central areas of low attenuation and peripheral enhancement (arrows).
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Figure 5. Pleural effusion. Axial contrast-enhanced CT scan demonstrates a large, right-sided pleural collection. The enhancing parietal pleura is uniformly thickened (arrows).
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Figure 6. Miliary tuberculosis. Frontal radiograph shows fine, discrete nodular areas of increased opacity bilaterally.
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Figure 7. Miliary tuberculosis. High-resolution CT scan obtained with lung windowing demonstrates numerous fine, discrete nodules bilaterally in a random distribution.
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Figure 8. Cavitary postprimary tuberculosis. Frontal radiograph demonstrates a thick-walled cavity with smooth inner margins in the left upper lobe (arrow).
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Figure 9a. Cavitary postprimary tuberculosis. (a) Axial contrast-enhanced CT scan obtained with mediastinal windowing demonstrates an enlarged mediastinal lymph node with a central area of low attenuation (arrow). (b) Axial CT scan obtained with lung windowing demonstrates ill-defined cavities (black arrows) accompanied by endobronchial spread in the right upper lobe (white arrow).
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Figure 9b. Cavitary postprimary tuberculosis. (a) Axial contrast-enhanced CT scan obtained with mediastinal windowing demonstrates an enlarged mediastinal lymph node with a central area of low attenuation (arrow). (b) Axial CT scan obtained with lung windowing demonstrates ill-defined cavities (black arrows) accompanied by endobronchial spread in the right upper lobe (white arrow).
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Figure 10. Fibroproliferative disease. Axial CT scan demonstrates bilateral diffuse, coarse, linear, and nodular areas of increased attenuation with cavitation (arrows).
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Figure 11. Fibroproliferative disease. Frontal chest radiograph shows clumped nodular and linear areas of increased opacity in both upper lobes and in the right middle lobe (white arrows). There is accompanying volume loss in the right upper lobe as well as overlying apical pleural thickening (black arrow).
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Figure 12. Lung destruction in postprimary tuberculosis. Axial CT scan demonstrates a fibrotic, shrunken left lung with compensatory overexpansion of the right lung extending across the midline. Bronchiectatic changes are noted bilaterally (arrows).
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Figure 13. Bronchiectasis in postprimary tuberculosis. Axial CT scan demonstrates bronchiectasis in the left lung (arrows) with areas of emphysema.
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Figure 14. Endobronchial spread of tuberculosis. Axial CT scan shows severe changes of bronchiolar dilatation and impaction. Bronchiolar wall thickening (straight arrows) and mucoid impaction of contiguous branching bronchioles produce a tree-in-bud appearance (curved arrows).
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Figure 15a. Cavitary tuberculosis associated with aspergilloma. (a) Frontal radiograph shows a cavity in the left upper lobe (black arrow) with a dependent area of soft-tissue opacity (solid white arrow). The crescentic area of hyperlucency (open arrow) represents residual air in the cavity and is referred to as the air crescent sign. (b) Axial CT scan shows dependent soft-tissue aspergilloma (black arrow) within the cavity (solid white arrow), along with the air crescent sign (open arrow).
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Figure 15b. Cavitary tuberculosis associated with aspergilloma. (a) Frontal radiograph shows a cavity in the left upper lobe (black arrow) with a dependent area of soft-tissue opacity (solid white arrow). The crescentic area of hyperlucency (open arrow) represents residual air in the cavity and is referred to as the air crescent sign. (b) Axial CT scan shows dependent soft-tissue aspergilloma (black arrow) within the cavity (solid white arrow), along with the air crescent sign (open arrow).
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Figure 16. Tuberculous bronchostenosis. Axial CT scan demonstrates narrowing of the right main bronchus (arrow).
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Figure 17a. Tuberculous broncholithiasis. (a) Chest radiograph demonstrates partial atelectasis of the right upper lobe (straight arrow) with calcified hilar lymph nodes bilaterally (curved arrows). (b) Axial CT scan demonstrates erosion of the right main bronchus (straight solid arrow) by a calcified hilar lymph node (curved arrow). A calcified precarinal lymph node is also noted (open arrow). The differential diagnosis for mediastinal lymph node calcification includes histoplasmosis, silicosis, and treated lymphoma.
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Figure 17b. Tuberculous broncholithiasis. (a) Chest radiograph demonstrates partial atelectasis of the right upper lobe (straight arrow) with calcified hilar lymph nodes bilaterally (curved arrows). (b) Axial CT scan demonstrates erosion of the right main bronchus (straight solid arrow) by a calcified hilar lymph node (curved arrow). A calcified precarinal lymph node is also noted (open arrow). The differential diagnosis for mediastinal lymph node calcification includes histoplasmosis, silicosis, and treated lymphoma.
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Figure 18. Tuberculous involvement of the left sternoclavicular joint. Oblique radiograph demonstrates irregularity of the medial end of the left clavicle (black arrow) with an associated soft-tissue mass (white arrow).
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Figure 19. Plombage in a patient with postprimary tuberculosis. Frontal chest radiograph demonstrates typical right-sided Lucite ball plombage. There is thinning and disorganization of the overlying ribs (straight arrow). Air-fluid levels in the Lucite balls (curved arrows) suggest bronchopleural fistulas.
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Figure 20. Tuberculoma of the right atrium in a patient with miliary tuberculosis. Axial T2-weighted magnetic resonance (MR) image demonstrates a hyperintense mass in the right atrium (straight arrow). Note also the right pleural effusion (curved arrow). The mass proved to be a tuberculoma at surgery.
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Figure 21. Tuberculous pericarditis in a patient with pleuropulmonary tuberculosis. Axial CT scan demonstrates pericardial thickening (straight solid arrow). Pulmonary tuberculomas (curved arrows) and a right pleural effusion (open arrow) are also seen.
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Figure 22. Tuberculous spondylitis. Lateral radiograph demonstrates obliteration of the disk space (straight arrow) with destruction of the adjacent end plates (curved arrow) and anterior wedging.
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Figure 23. Subligamentous spread of spinal tuberculosis. Lateral radiograph demonstrates erosion of the anterior margin of the vertebral body (arrow) caused by an adjacent soft-tissue abscess.
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Figure 24. Tuberculous spondylitis. Axial CT scan demonstrates lytic destruction of the vertebral body (black arrow) with an adjoining soft-tissue abscess (white arrow).
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Figure 25. Iliopsoas abscess. Axial CT scan demonstrates large, multiloculated iliopsoas abscesses bilaterally (arrowheads). Note also the presacral abscess (solid arrow) accompanied by erosion of the anterior sacrum (open arrow).
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Figure 26. Calcified psoas abscess. Axial CT scan demonstrates bilateral tuberculous psoas abscesses with peripheral calcification (arrows).
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Figure 27. Tuberculous spondylitis. Sagittal T2-weighted MR image demonstrates areas of increased signal intensity due to edema in vertebral bodies. Accompanying disk narrowing (white arrow) and extension of the disease into the spinal canal (black arrow) are also seen.
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Figure 28a. Tuberculous osteomyelitis involving the skull. (a) Axial contrast-enhanced CT scan demonstrates a bilobed, peripherally enhancing cold abscess centered along the right frontal bone (arrow, arrowhead). Note the significant edema and the mass effect on the underlying brain parenchyma. (b) Axial CT scan obtained with bone windowing demonstrates an ill-defined lytic area of bone destruction (arrow).
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Figure 28b. Tuberculous osteomyelitis involving the skull. (a) Axial contrast-enhanced CT scan demonstrates a bilobed, peripherally enhancing cold abscess centered along the right frontal bone (arrow, arrowhead). Note the significant edema and the mass effect on the underlying brain parenchyma. (b) Axial CT scan obtained with bone windowing demonstrates an ill-defined lytic area of bone destruction (arrow).
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Figure 29. Tuberculous osteomyelitis. Anteroposterior radiograph demonstrates a lytic area of bone destruction (arrow) with transphyseal spread of infection across the growth plate.
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Figure 30. Tuberculous arthritis of the knee joint. Frontal radiograph demonstrates periarticular osteopenia (black arrow), peripheral osseous erosions (white arrow), and relative preservation of the joint space.
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Figure 31. Tuberculous arthritis of the knee joint. Sagittal gadolinium-enhanced T1-weighted MR image demonstrates peripheral enhancement around the low-signal-intensity joint collection (straight arrow). Note the presence of marginal joint erosions (curved arrow). (Courtesy of Raju Sharma, MD, Department of Radiology, AIIMS, Delhi, India.)
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Figure 32. Tuberculous arthritis of the ankle joint. Sagittal T1-weighted MR image demonstrates hypointense periarticular effusions (black arrows) with bone erosion of the talus and tibia (white arrow).
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Figure 33. Ileocecal tuberculosis. Radiograph obtained with peroral pneumocolon technique demonstrates a conical and shrunken cecum (straight arrow) retracted out of the iliac fossa by contraction of the mesocolon. Note also the narrowing of the terminal ileum (curved arrow).
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Figure 34a. Ileocecal tuberculosis. (a) Axial CT scan demonstrates concentric cecal wall thickening (arrow). (b) Axial CT scan obtained caudad to a demonstrates diffuse thickening of the terminal ileum (arrow).
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Figure 34b. Ileocecal tuberculosis. (a) Axial CT scan demonstrates concentric cecal wall thickening (arrow). (b) Axial CT scan obtained caudad to a demonstrates diffuse thickening of the terminal ileum (arrow).
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Figure 35. Ileocecal tuberculosis and peritoneal tuberculosis (wet type). Axial CT scan demonstrates concentric thickening of the cecum (straight solid arrow). Small bowel dilatation (curved arrow), ascites in the greater peritoneal space, and thickening of the peritoneum (open arrow) are also seen.
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Figure 36. Peritoneal tuberculosis (dry type). Axial CT scan demonstrates thickening and infiltration of the peritoneum (white arrows) along with thickening of bowel loops. Note the small amount of loculated fluid (black arrow).
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Figure 37. Peritoneal tuberculosis (fibrotic type). Axial contrast-enhanced CT scan demonstrates enhancing thickened peritoneum (straight arrow) with an adjoining matted loop of small bowel (curved arrow).
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Figure 38. Abdominal tuberculous lymphadenitis. Axial contrast-enhanced CT scan demonstrates multiple enlarged mesenteric lymph nodes with central areas of low attenuation (arrow).
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Figure 39. Hepatic tuberculosis. Axial contrast-enhanced CT scan demonstrates multiple nonuniform, low-attenuation lesions within the liver (straight arrows). An enlarged gastrohepatic lymph node is also seen (curved arrow).
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Figure 40. Renal tuberculosis. Chest radiograph that includes the upper abdomen demonstrates lobar calcification in the right kidney (black arrow). Note also the bilateral fibrocalcific changes in the upper lobes (white arrows).
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Figure 41. Tuberculous pyonephrosis. Retrograde pyelogram shows filling of the dilated hydronephrotic lower and middle pole of the right kidney. The collecting system has irregular margins (straight solid arrow) and shows irregular filling defects (curved arrow) from necrosis of the parenchyma. Upper pole calcification is also seen (open arrow).
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Figure 42. Renal tuberculosis. Axial contrast-enhanced CT scan demonstrates left tuberculous pyonephrosis (straight solid arrow) with extension of the inflammatory process into the perinephric space (curved arrow) and accompanying peritoneal disease (open arrow).
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Figure 43. Adrenal tuberculosis. Axial contrast-enhanced CT scan demonstrates bilateral adrenal masses with central low-attenuation areas (arrows).
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Figure 44. Bladder tuberculosis. Axial contrast-enhanced CT scan demonstrates a thickened and deformed bladder with an enhancing wall (straight arrow). There is extension of the inflammatory process to the anterior abdominal wall (curved arrow).
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Figure 45. Bladder tuberculosis. Intravenous urogram demonstrates a thickened, contracted, low-capacity bladder (thimble bladder) (arrowhead) with minimal dilatation of both ureters.
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Figure 46. Endometrial tuberculosis. Hysterosalpingogram demonstrates an obliterated and deformed endometrial cavity (arrow) due to tuberculous endometritis.
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Figure 47. Cranial tuberculous meningitis. Axial gadolinium-enhanced T1-weighted MR image demonstrates leptomeningeal enhancement along the left sylvian fissure (straight arrow). There is an accompanying ring-enhancing granuloma in the left parieto-occipital region (curved arrow).
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Figure 48. Cranial tuberculomas. Axial contrast-enhanced CT scan demonstrates multiple ring-enhancing lesions (straight arrows) along with diffuse meningeal enhancement (curved arrow).
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Figure 49. Solid caseating tuberculous granulomas involving the cerebellum. Axial T2-weighted MR image demonstrates multiple granulomas with central areas of hypointensity in the cerebellum (arrows).
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Figure 50. Tuberculous granulomas involving the cerebellum. Axial T1-weighted MR image demonstrates isointense lesions with mildly hyperintense rims in the cerebellum (arrows).
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Figure 51. Bilateral tuberculous mastoiditis. High-resolution CT scan of the temporal bone demonstrates bilateral destructive lesions in the mastoid processes (straight arrows). There is an accompanying cold abscess overlying the right temporo-occipital region (curved arrow).
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Figure 52. Orbital tuberculosis. Axial contrast-enhanced CT scan demonstrates an enhancing retinal lesion in the left orbit (arrow).
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Copyright © 2000 by the Radiological Society of North America.
