Pulmonary Tuberculosis Mimicking Pneumonia on CT : Retrospective Analysis of Clinical and CT Features.

Paeng, Mi Hye; Kim, Yoo Kyung; Shim, Sung Shin; Chang, Jung Hyun; Lee, Jin Hwa; Kwag, Hyon Joo

doi:2003.55.1.31

Tuberc Respir Dis > Volume 55(1); 2003 > Article

Original Article

Tuberculosis and Respiratory Diseases 2003;55(1):31-40.
DOI: https://doi.org/10.4046/trd.2003.55.1.31 Published online July 1, 2003.

Pulmonary Tuberculosis Mimicking Pneumonia on CT : Retrospective Analysis of Clinical and CT Features.

Mi Hye Paeng, Yoo Kyung Kim, Sung Shin Shim, Jung Hyun Chang, Jin Hwa Lee, Hyon Joo Kwag

¹Department of Diagnostic Radiology, College of Medicine, Ewha Womans University, Korea. yookkim@ewha.ac.kr
²Department of Internal Medicine, College of Medicine, Ewha Womans University, Korea.
³Department of Radiology, Kangbuk Samsung Hospital, Samsung Medical Center, Korea.

Abstract

BACKGROUND
A CT scan is a useful modality for the diagnosis and evaluation of disease activity in patients with pulmonary tuberculosis. However, the CT diagnosis of pulmonary tuberculosis is sometimes difficult in patients with an atypical CT pattern, especially with lobar consolidation mimicking pneumonia. The aim of this study was to evaluate the clinical and CT features of pulmonary tuberculosis, simulating pneumonia, from a CT scan. MATERIALS AND METHODS: The clinical and CT features in 21 patients, where the CT diagnosis was pneumonia, or the CT differential diagnosis included pneumonia, were retrospectively analyzed. RESULTS: Of the 21 patients, 6 were immunocompromised, 15 presented with fever or leukocytosis and 15 showed positive sputum smear test for acid fast bacilli. Also, 17 of the 21 patients showed a positive sputum culture test. On the CT scan, consolidation was noted in all patients (100%), volume loss of the involved lobe or segment in 12 (57%), bronchogenic spread in 15 (71%), a cavity in 7 (33%) and bronchial wall thickening also in 7 (33%). The location of the consolidation revealed a relatively even distribution, with no specific predilection site. The other associated pulmonary diseases included ARDS, bronchiectasis, severe pulmonary emphysema, idiopathic pulmonary fibrosis and pulmonary alveolar proteinosis. CONCLUSION: In the immunocompromised patients, or patients with an underlying pulmonary disease, whose CT scans showed pulmonary consolidation, especially in association with findings of bronchogenic spread, a cavity or bronchial wall thickening, meticulous examination for pulmonary tuberculosis is recommended.

Key Words: Lung, CT, Tuberculosis, pulmonary