TUBERCULOSIS PARU
WENDY WONGSO
I111 11 025
KEPANITERAAN KLINIK RADIOLOGI RS UNTAN
PERIODE 29 FEBRUARI 2016 26 MARET 2016
TUBERCULOSIS
Tuberculosis is a chronic infection caused by
Mycobacterium tuberculosis , affecting mainly the
respiratory tract, though it can involve any system in
the body. The immigrant population, debilitated or
immunosuppressed patients are all prone to the
infection.
The evaluation of a patient with suspected TB should
begin with a Mantoux skin test (purified protein
derivative [PPD]) and a chest x-ray. Pulmonary TB has
primary or secondary forms with a variety of
Pemeriksaan Radiologi
Pada tuberculosis paru, pemeriksaan foto toraks dapat
menjadi pemeriksaan usulan namun bukan sebagai
diagnosa utama.
Pemeriksaan
foto
thorak
dapat
menyingkirkan
kemungkinan TB paru pada orang-orang dengan tes
tuberculin (+) dan tanpa gejala.
Pembuatan foto thoraks dengan proyeksi PA (Posterior
Anterior), bila perlu disertai dengan proyeksi-proyeksi
lain seperti foto lateral dan foto khusus puncak AP-
Kemungkinan-Kemungkinan
Kelanjutan Suatu Sarang
Tuberkulosis
Penyembuhan
Perburukan
Pleuritis
Penyebaran miliar
Stenosis bronkus
Timbulnya lubang (cavitas)
Primary Tuberculosis
Primary TB begins as initial inoculation in the lungs.
Most healthy patients will contain the infection with no radiographic abnormality. Therefore,
most PPD-positive patients will have a normal chest radiograph.
Some primary infections will create enough of an inflammatory response to produce calcified
nodule(s) and thoracic lymph node(s).
When this occurs, it leaves a characteristic radiographic pattern known as the primary
inflammatory complex or Ranke complex. However, this complex is not specific for TB.
It is also commonly seen with fungal or histoplasmosis infection, particularly in the central and
eastern regions of the United States.
Nevertheless, it does indicate inactive disease. Immunocompromised or chronically ill patients
with primary TB usually have radiographic abnormalities.
This includes nonspecific consolidation, cavitary nodules and masses, small miliary,
necrotizing adenopathy, and pleural effusions. In fact, in a patient with known TB, a
cavitary nodule or mass with an airfluid level is considered diagnostic for transmissible disease
and the patient should be immediately isolated in a negative pressure environment.
Secondary Tuberculosis
The secondary form of TB involves reactivation of dormant foci of infection.
The infection thrives in areas of high oxygen concentration, particularly the
upper lobes.
Fibronodular consolidation may occur with or without cavitation and
adenopathy.
In end stage of reactivation TB, there is fibrosis and scarring with volume
loss, shift of fissures and/or vessels, and calcification.
Once again, old chest radiographs are crucial in these cases to assess for
interval change.
Any patient with a radiograph suggestive of TB should have a study at least 6
months prior made available for review.
Any new changes may indicate reactivation disease.
Normal Lung
Nodular Shadowing
Consolidation
Intestitial shadowing
Primary Tuberculosis. A
posteroanterior chest radiograph in
a 32-year old homeless man shows
airspace disease within the anterior
segment of the right upper lobe ,
with right hilar (skinny arrow) and
paratracheal (fat arrow) node
enlargement.
TERIMA KASIH