Pulmonary tuberculosis: tomographic evaluation in the active and post-treatment phases.
BACKGROUND
Adequate knowledge of images consistent with tuberculosis activity is an important resource for tuberculosis diagnosis and treatment.


OBJECTIVE
To evaluate the structural alterations caused by tuberculosis in the pulmonary parenchyma, both during the active phase of the disease and after the end of the treatment, through computerized tomography of the thorax.


METHODS
Prospective study.


METHODS
Pulmonary Division, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo.


METHODS
20 patients, carriers of pulmonary tuberculosis, confirmed by Mycobacterium tuberculosis culture.


METHODS
Conventional tomography scans of the patients were obtained at two times: upon diagnosis and after the end of the treatment. The following were considered suggestive signs of tuberculosis activity: centrilobular nodules with segmented distribution, confluent micronodules, consolidations, thick-walled cavities, nodules, masses, thickening of the bronchial walls, tree-in-bud appearance and cylindrical bronchiectasis.


METHODS
The presence of suggestive signs of tuberculosis activity was compared between the start and the end of treatment by means of the signs test (z).


RESULTS
All patients (20/20) presented suggestive signs of tuberculosis activity at the start of treatment. After the end of treatment, 13 patients (13/20) still presented some suggestive signs consistent with activity. A reduction in the extent of lung attack was seen post-treatment, in relation to its start (z = 10.10). This change was statistically significant (p < 0.001).


CONCLUSIONS
Signs suggestive of tuberculosis activity are present in the active disease and are seen via computed tomography. The extent of parenchymal attack significantly decreases following treatment. Such signs may be useful in the diagnosis of pulmonary tuberculosis.
Bombarda
Sidney
S
Pulmonary Division, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. sbombarda@ig.com.br
Figueiredo
Cláudia Maria
CM
Seiscento
Márcia
M
Terra Filho
Mário
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging* / Q000188:drug therapy
D000995:Antitubercular Agents