title: [Study on clinico-pathological features of active pulmonary tuberculosis found at autopsy in a general hospital].
abstract: OBJECTIVE
  To clarify clinico-pathological features of tuberculosis found at autopsy.
  
  
  METHODS
  This study investigates 18 (3.7%) of active pulmonary tuberculosis out of 489 autopsy in Tachikawa Sougo Hospital during the period from 1992 to 2005.
  
  
  RESULTS
  There were 11 men and 7 women, with a median age of 69.5 years. Tubercle bacilli were proved from sputum in 6, which consisted of 3 with positivity on sputum smear microscopy and culture, and 3 with positivity only on sputum culture. Two were examined, but not diagnosed before death. Three didn't show any positive result despite of repeated sputum tests. The features of the chest radiological findings were: (1) Shadows that present prior tuberculosis (ex: nodules, fibrotic lesion) were found in 9 and ground-glass-opacity in 5. (2) In 6, radiological findings consistent with tuberculosis were not pointed out because shadows such as fibrosis, pleural effusion, or cancer were mixed in the same lung. (3) In 11, main radiological findings were found in atypical segments, when there were some underlying conditions such as the use of corticosteroidal therapy or diabetes mellitus. Four were diagnosed correctly, and treated with anti-tuberculosis drugs. Other 14 were not diagnosed before death and diagnosed wrongly as pneumonia, cancer, or other diseases. Encapsulated caseous nodules were seen in 7, and autopsy confirmed that 12 including these 7 were caused by endogenous reactivation. Miliary tuberculosis was found in 5, caseous pneumonia/bronchitis in 6. One had tuberculous empyema. As to underlying diseases, 8 had malignant disease, 6 had diabetes mellitus and 6 were treated with corticosteroids.
  
  
  CONCLUSIONS
  This study suggests that sputum culture or radiological findings are not sufficient enough to diagnose tuberculosis, especially in compromised host. We emphasize the vital role of treatment for latent tuberculosis for cases with high risk of endogenous reactivation, and it's necessary to make the guideline for the treatment of such latent tuberculosis.
authors.affiliation: Mishima Kyoritsu Hospital, Mishima-shi, Shizuoka, Japan. kanrijimu@mishima-kyouritsu.com
authors.forename: Akito
authors.initials: A
authors.lastname: Yamamoto
authors.forename: Kayoko
authors.initials: K
authors.lastname: Tsuchiya
authors.forename: Kenji
authors.initials: K
authors.lastname: Kusajima
authors.forename: Hisao
authors.initials: H
authors.lastname: Shimoide
authors.forename: Maki
authors.initials: M
authors.lastname: Nunomura
authors.forename: Akira
authors.initials: A
authors.lastname: Hebisawa
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D005260:Female; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007564:Japan; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000473:pathology
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents