title: Clinicoradiologic evidence of pulmonary lymphatic spread in adult patients with tuberculosis.
abstract: OBJECTIVE
  The purpose of this study is to evaluate the prevalence and clinicoradiologic characteristics of pulmonary tuberculosis with lymphatic involvement.
  
  
  METHODS
  A total of 126 adults with active tuberculosis who underwent CT were enrolled. A retrospective investigation of CT images focused on the presence of perilymphatic micronodules, as well as other CT features of active tuberculosis. We selected two groups of patients with micronodules according to distribution (perilymphatic vs centrilobular). We compared clinical and CT findings between the two groups.
  
  
  RESULTS
  Fifteen patients were excluded because of coexisting pulmonary disease. Among 111 patients, the prevalence of perilymphatic micronodules, galaxy or cluster signs, and interlobular septal thickening was 64 (58%), 18 (16%), and 30 (27%), respectively. Of 106 patients with micronodules, 37 and 40 were classified into the perilymphatic and centrilobular groups, respectively. Compared with the centrilobular group, the perilymphatic group had statistically significantly lower frequencies of positive acid-fast bacilli smears (32% vs 70%), consolidation (70% vs 98%), and cavitation (30% vs 60%). However, frequencies of interlobular septal thickening (41% vs 18%), galaxy or cluster signs (30% vs 0%), and pleural effusion (43% vs 20%) were statistically significantly higher in the perilymphatic group.
  
  
  CONCLUSIONS
  CT findings representing pulmonary perilymphatic involvement are relatively common in adults with tuberculosis. These findings may represent lymphatic spread of tuberculosis and provide an explanation for the unusual CT features of pulmonary tuberculosis mimicking sarcoidosis and the low detection of Mycobacterium tuberculosis in patients with micronodules.
authors.affiliation: 1 Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Ji-dong, Paldal-gu, Suwon, Kyeonggi-do 442-723, Republic of Korea.
authors.forename: Jeong Min
authors.initials: JM
authors.lastname: Ko
authors.forename: Hyun Jin
authors.initials: HJ
authors.lastname: Park
authors.forename: Chi Hong
authors.initials: CH
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014388:Tuberculosis, Lymph Node / Q000175:diagnosis* / Q000453:epidemiology*; D055815:Young Adult
keywords: CT; lymphatics; micronodules; pulmonary tuberculosis