title: Pulmonary Tuberculosis: Role of Radiology in Diagnosis and Management.
abstract: Tuberculosis is a public health problem worldwide, including in the United States-particularly among immunocompromised patients and other high-risk groups. Tuberculosis manifests in active and latent forms. Active disease can occur as primary tuberculosis, developing shortly after infection, or postprimary tuberculosis, developing after a long period of latent infection. Primary tuberculosis occurs most commonly in children and immunocompromised patients, who present with lymphadenopathy, pulmonary consolidation, and pleural effusion. Postprimary tuberculosis may manifest with cavities, consolidations, and centrilobular nodules. Miliary tuberculosis refers to hematogenously disseminated disease that is more commonly seen in immunocompromised patients, who present with miliary lung nodules and multiorgan involvement. The principal means of testing for active tuberculosis is sputum analysis, including smear, culture, and nucleic acid amplification testing. Imaging findings, particularly the presence of cavitation, can affect treatment decisions, such as the duration of therapy. Latent tuberculosis is an asymptomatic infection that can lead to postprimary tuberculosis in the future. Patients who are suspected of having latent tuberculosis may undergo targeted testing with a tuberculin skin test or interferon-γ release assay. Chest radiographs are used to stratify for risk and to assess for asymptomatic active disease. Sequelae of previous tuberculosis that is now inactive manifest characteristically as fibronodular opacities in the apical and upper lung zones. Stability of radiographic findings for 6 months distinguishes inactive from active disease. Nontuberculous mycobacterial disease can sometimes mimic the findings of active tuberculosis, and laboratory confirmation is required to make the distinction. Familiarity with the imaging, clinical, and laboratory features of tuberculosis is important for diagnosis and management.©RSNA, 2017.
authors.affiliation: From the Department of Radiology, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Suite 130, Philadelphia, PA 19104 (A.C.N., E.J.M.B., S.I.K., M.M.H.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.R.); Department of Radiology (X.S.) and Department of Medicine, Section of Pulmonary and Critical Care Medicine (E.S.G.), Baylor College of Medicine, Houston, Tex; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.); Department of Diagnostic and Interventional Imaging, University of Texas Medical School at Houston, Houston, Tex (D.O.); and Department of Radiology, Texas Children's Hospital, Houston, Tex (A.E.S.).
authors.forename: Arun C
authors.initials: AC
authors.lastname: Nachiappan
authors.affiliation: From the Department of Radiology, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Suite 130, Philadelphia, PA 19104 (A.C.N., E.J.M.B., S.I.K., M.M.H.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.R.); Department of Radiology (X.S.) and Department of Medicine, Section of Pulmonary and Critical Care Medicine (E.S.G.), Baylor College of Medicine, Houston, Tex; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.); Department of Diagnostic and Interventional Imaging, University of Texas Medical School at Houston, Houston, Tex (D.O.); and Department of Radiology, Texas Children's Hospital, Houston, Tex (A.E.S.).
authors.forename: Kasra
authors.initials: K
authors.lastname: Rahbar
authors.affiliation: From the Department of Radiology, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Suite 130, Philadelphia, PA 19104 (A.C.N., E.J.M.B., S.I.K., M.M.H.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.R.); Department of Radiology (X.S.) and Department of Medicine, Section of Pulmonary and Critical Care Medicine (E.S.G.), Baylor College of Medicine, Houston, Tex; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.); Department of Diagnostic and Interventional Imaging, University of Texas Medical School at Houston, Houston, Tex (D.O.); and Department of Radiology, Texas Children's Hospital, Houston, Tex (A.E.S.).
authors.forename: Xiao
authors.initials: X
authors.lastname: Shi
authors.affiliation: From the Department of Radiology, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Suite 130, Philadelphia, PA 19104 (A.C.N., E.J.M.B., S.I.K., M.M.H.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.R.); Department of Radiology (X.S.) and Department of Medicine, Section of Pulmonary and Critical Care Medicine (E.S.G.), Baylor College of Medicine, Houston, Tex; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.); Department of Diagnostic and Interventional Imaging, University of Texas Medical School at Houston, Houston, Tex (D.O.); and Department of Radiology, Texas Children's Hospital, Houston, Tex (A.E.S.).
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Guy
authors.affiliation: From the Department of Radiology, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Suite 130, Philadelphia, PA 19104 (A.C.N., E.J.M.B., S.I.K., M.M.H.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.R.); Department of Radiology (X.S.) and Department of Medicine, Section of Pulmonary and Critical Care Medicine (E.S.G.), Baylor College of Medicine, Houston, Tex; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.); Department of Diagnostic and Interventional Imaging, University of Texas Medical School at Houston, Houston, Tex (D.O.); and Department of Radiology, Texas Children's Hospital, Houston, Tex (A.E.S.).
authors.forename: Eduardo J
authors.initials: EJ
authors.lastname: Mortani Barbosa
authors.affiliation: From the Department of Radiology, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Suite 130, Philadelphia, PA 19104 (A.C.N., E.J.M.B., S.I.K., M.M.H.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.R.); Department of Radiology (X.S.) and Department of Medicine, Section of Pulmonary and Critical Care Medicine (E.S.G.), Baylor College of Medicine, Houston, Tex; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.); Department of Diagnostic and Interventional Imaging, University of Texas Medical School at Houston, Houston, Tex (D.O.); and Department of Radiology, Texas Children's Hospital, Houston, Tex (A.E.S.).
authors.forename: Girish S
authors.initials: GS
authors.lastname: Shroff
authors.affiliation: From the Department of Radiology, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Suite 130, Philadelphia, PA 19104 (A.C.N., E.J.M.B., S.I.K., M.M.H.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.R.); Department of Radiology (X.S.) and Department of Medicine, Section of Pulmonary and Critical Care Medicine (E.S.G.), Baylor College of Medicine, Houston, Tex; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.); Department of Diagnostic and Interventional Imaging, University of Texas Medical School at Houston, Houston, Tex (D.O.); and Department of Radiology, Texas Children's Hospital, Houston, Tex (A.E.S.).
authors.forename: Daniel
authors.initials: D
authors.lastname: Ocazionez
authors.affiliation: From the Department of Radiology, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Suite 130, Philadelphia, PA 19104 (A.C.N., E.J.M.B., S.I.K., M.M.H.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.R.); Department of Radiology (X.S.) and Department of Medicine, Section of Pulmonary and Critical Care Medicine (E.S.G.), Baylor College of Medicine, Houston, Tex; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.); Department of Diagnostic and Interventional Imaging, University of Texas Medical School at Houston, Houston, Tex (D.O.); and Department of Radiology, Texas Children's Hospital, Houston, Tex (A.E.S.).
authors.forename: Alan E
authors.initials: AE
authors.lastname: Schlesinger
authors.affiliation: From the Department of Radiology, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Suite 130, Philadelphia, PA 19104 (A.C.N., E.J.M.B., S.I.K., M.M.H.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.R.); Department of Radiology (X.S.) and Department of Medicine, Section of Pulmonary and Critical Care Medicine (E.S.G.), Baylor College of Medicine, Houston, Tex; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.); Department of Diagnostic and Interventional Imaging, University of Texas Medical School at Houston, Houston, Tex (D.O.); and Department of Radiology, Texas Children's Hospital, Houston, Tex (A.E.S.).
authors.forename: Sharyn I
authors.initials: SI
authors.lastname: Katz
authors.affiliation: From the Department of Radiology, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Suite 130, Philadelphia, PA 19104 (A.C.N., E.J.M.B., S.I.K., M.M.H.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.R.); Department of Radiology (X.S.) and Department of Medicine, Section of Pulmonary and Critical Care Medicine (E.S.G.), Baylor College of Medicine, Houston, Tex; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.); Department of Diagnostic and Interventional Imaging, University of Texas Medical School at Houston, Houston, Tex (D.O.); and Department of Radiology, Texas Children's Hospital, Houston, Tex (A.E.S.).
authors.forename: Mark M
authors.initials: MM
authors.lastname: Hammer
mesh_terms: D015373:Bacterial Typing Techniques / Q000379:methods*; D003937:Diagnosis, Differential; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D013902:Radiography, Thoracic / Q000379:methods*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*