Atypical Computed Tomography Features of Pulmonary Tuberculosis: Findings and Diagnostic Challenges
Main Article Content
Abstract
Pulmonary tuberculosis, caused by Mycobacterium tuberculosis, remains a global health concern, with diverse clinical presentations that can often pose diagnostic challenges. While conventional imaging modalities such as chest X-rays have been crucial in screening and diagnosis, limitations in sensitivity and specificity have led to an increased reliance on computed tomography imaging that plays a pivotal role in identifying features that may not be readily apparent on standard radiographs. However, computed tomography scans may show subtle and unique features that can overlap with other respiratory conditions leading to a delay in diagnosis and treatment. They mainly include uncommon lung lesions (like masses, solitary or multiple nodules, cystic lesions, ground glass opacities and reversed halo sign) and location particularly to the lower lobes as well as the association with other pulmonary conditions like emphysema, interstitial lung disease and lung cancer.
This paper aims to elucidate the atypical computed tomography features of pulmonary tuberculosis that clinicians and radiologists should be mindful of to improve diagnostic accuracy.
Keywords:
Pulmonary tuberculosis, computed tomography, mass, nodule, cyst, ground glass opacity, reversed halo sign, lung lower lobe, diffuse lung disease
Article Details
How to Cite
NÈJI, Henda et al.
Atypical Computed Tomography Features of Pulmonary Tuberculosis: Findings and Diagnostic Challenges.
Medical Research Archives, [S.l.], v. 12, n. 9, oct. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5899>. Date accessed: 27 dec. 2024.
doi: https://doi.org/10.18103/mra.v12i9.5899.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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23. Tokuyama Y, Matsumoto T, Kusakabe Y, Yamamoto N, Aihara K, Yamaoka S, Mishima M. Ground-glass opacity as a paradoxical reaction in miliary tuberculosis: A case report and review of the literature. IDCases. 2019;19:e00685. doi: 10.1016/j.idcr.2019.e00685.
24. Nattusamy L, Madan K, Bhalla AS, Guleria R. Reversed halo sign in active pulmonary tuberculosis. BMJ Case Rep. 2014;2014:bcr2013202981. doi: 10.1136/bcr-2013-202981.
25. Zhan X, Zhang L, Wang Z, Jin M, Liu M, Tong Z. Reversed Halo Sign: Presents in Different Pulmonary Diseases. PLoS One. 2015;10(6):e01 28153. doi: 10.1371/journal.pone.0128153.
26. Martini K, Loubet A, Bankier A, Bouam S, Morand P, Cassagnes L, Revel MP, Chassagnon G. Nodular reverse halo sign in active pulmonary tuberculosis: A rare CT feature? Diagn Interv Imaging. 2020;101(5):281-287.
doi: 10.1016/j.diii.2020.01.013.
27. Maturu VN, Agarwal R. Reversed halo sign: a systematic review. Respir Care. 2014;59(9):1440-9. doi: 10.4187/respcare.03020.
28. Marchiori E, Zanetti G, Irion KL, Nobre LF, Hochhegger B, Mançano AD, Escuissato DL. Reversed halo sign in active pulmonary tuberculosis: criteria for differentiation from cryptogenic organizing pneumonia. Am J Roentgenol. 2011;197(6):1324-7. doi: 10.2214/AJR.11.6543.
29. Van LD, Le HN, Pletschette M, Nguyen AT, Nguyen TH, Nguyen NBT. Cystic pulmonary tuberculosis: A rare form of an ancient disease. Respirology Case Reports. 2022;10:e01020. doi.org/10.1002/rcr2.1020
30. Perim J, Pimenta ES, Marchiori E. Cystic tuberculosis: a very unusual aspect of a common disease. Pulmonology. 2020;26(6):400-403. doi: 10.1016/j.pulmoe.2019.12.001.
31. Ray A, Suri JC, Sen MK, Khanna A. Cystic lung disease in tuberculosis: An unusual presentation. Lung India. 2013;30(4):351-3. doi: 10.4103/0970-2113.120620.
32. Ray A, Suri JC, Sen MK, Khanna A. Cystic lung disease in tuberculosis: An unusual presentation. Lung India. 2013;30(4):351-3. doi: 10.4103/0970-2113.120620.
33. Cukic V. The Association Between Lung Carcinoma and Tuberculosis. Med Arch. 2017;71 (3):212-214. doi: 10.5455/medarh.2017.71.212-214.
34. Lee HJ, Goo JM, Im JG. Rapid and irreversible cystic change of pulmonary tuberculosis in an immunocompetent adult. J Thorac Imaging. 2003; 18(4):254-6. doi: 10.1097/00005382-200310000-00009.
35. Kodati R, Tadepalli A, Reddy C. Pulmonary tuberculosis presenting as diffuse cystic lung disease: An atypical manifestation. Indian J Tuberc. 2020;67(3):397-399. doi: 10.1016/j.ijtb.2019.11.016.
36. Hantous-Zannad S, Néji H, Affes M, Attia M, Baccouche I, Kechaou S, Tritar F, Ben Miled-M’rad Kh. Imaging of thoracic tuberculosis. In M. F. Ladeb, W. C. G. Peh (eds.), Imaging of Tuberculosis, Medical Radiology Diagnostic Imaging, https://doi.org/10.1007/978-3-031-07040-2_8
37. Jeon KN, Ha JY, Park MJ, Bae K, Baek HJ, Choi BH, Cho SB, Moon JI, Kim HC. Pulmonary Tuberculosis in Patients With Emphysema: Computed Tomography Findings. J Comput Assist Tomogr. 2016;40(6):912-916.
doi: 10.1097/RCT.0000000000000452.
38. Sershen CL, Salim T and May EE (2023), Investigating the comorbidity of COPD and tuberculosis, a computational study. Front. Syst. Biol. 3:940097.doi: 10.3389/fsysb.2023.940097.
39. Ogawa K, Kurosaki A, Miyamoto A, Takahashi Y, Murase K, Hanada S, Uruga H, Takaya H, Morokawa N, Kishi K. Clinicoradiological Features of Pulmonary Tuberculosis with Interstitial Pneumonia. Intern Med. 2019;58(17):2443-2449. doi: 10.2169/internalmedicine.2341-18.
40. Wong C, Sahni S, Cheema MAI, Iftikhar A. Mycobacterium tuberculosis Infection in the Setting of Interstitial Lung Disease: Coincidence or Bad Luck? Cureus. 2018;10(10):e3391.
doi: 10.7759/cureus.3391.
41. Akhter N, Rizvi NA. Interstitial Lung Diseases Misdiagnosed as Tuberculosis. Pak J Med Sci. 2018; 34(2):338-341. doi: 10.12669/pjms.342.14407.
42. Ehrlich R, Akugizibwe P, Siegfried N, Rees D. The association between silica exposure, silicosis and tuberculosis: a systematic review and meta-analysis. BMC Public Health. 2021;21(1):953. doi: 10.1186/s12889-021-10711-1.
43. Lanzafame M, Vento S. Mini-review: Silico-tuberculosis. J Clin Tuberc Other Mycobact Dis. 2021; 23:100218. doi: 10.1016/j.jctube.2021.100218.
44. Pedroso A, Ferreira I, Chikura T. Tuberculosis and Sarcoidosis Overlap: A Clinical Challenge From Diagnosis to Treatment. Cureus. 2020;12(11):e11662. doi: 10.7759/cureus.11662.
45. Hantous-Zannad S, Zidi A, Néji H, Attia M, Baccouche I, Ben Miled-M'rad K. Apport de l'imagerie dans la tuberculose thoracique [The role of imaging in thoracic tuberculosis]. Rev Pneumol Clin. 2015;71(2-3):93-109.
doi: 10.1016/j.pneumo.2014.02.006.
46. Cabrera-Sanchez J, Cuba V, Vega V, Van der Stuyft P, Otero L. Lung cancer occurrence after an episode of tuberculosis: a systematic review and meta-analysis. Eur Respir Rev. 2022;31(165):220025. doi: 10.1183/16000617.0025-2022.
47. Hwang SY, Kim JY, Lee HS, Lee S, Kim D, Kim S, Hyun JH, Shin JI, Lee KH, Han SH, Song YG. Pulmonary Tuberculosis and Risk of Lung Cancer: A Systematic Review and Meta-Analysis. J Clin Med. 2022;11(3):765. doi: 10.3390/jcm11030765.
2. WHO consolidated guidelines on tuberculosis. Module 2: screening – systematic screening for tuberculosis disease. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO
3. Kim JH, Kim MJ, Ham SY. Clinical characteristics and chest computed tomography findings of smear-positive and smear-negative pulmonary tuberculosis in hospitalized adult patients. Medicine (Baltimore). 2019;98(34):e16921. doi: 10.1097/MD.0000000000016921.
4. Rana, A., Krishnan, V. & Aggarwal, A. Unusual patterns of tuberculosis on cross-sectional imaging: a pictorial review. Egypt J Radiol Nucl Med. 2022;53:190 doi:10.1186/s43055-022-00875-0
5. Wei S, Shi B, Zhang J, Li N. Differentiating mass-like tuberculosis from lung cancer based on radiomics and CT features. Transl Cancer Res. 2021;10(10):4454-4463. doi: 10.21037/tcr-21-1719.
6. Afriyie-Mensah JS, Awindaogo FR, Asomani SK. Pseudotumour presentation of pulmonary tuberculosis. Ghana Med J. 2020;54(2):126-130. doi: 10.4314/gmj.v54i2.12.
7. Agarwal R, Srinivas R, Aggarwal AN. Parenchymal pseudotumoral tuberculosis: case series and systematic review of literature. Respir Med. 2008;102(3):382-9. doi: 10.1016/j.rmed.2007.10.017.
8. Zayet S, Berriche A, Ammari L, Kanoun F, Kilani B, Benaissa HT. Pseudotumoural pulmonary tuberculosis: a case series. IJID Reg. 2022;2:158-161. doi: 10.1016/j.ijregi.2022.01.009.
9. Xiang Y, Huang C, He Y and Zhang Q (2021) Cancer or Tuberculosis: A Comprehensive Review of the Clinical and Imaging Features in Diagnosis of the Confusing Mass. Front. Oncol. 11:644150. doi: 10.3389/fonc.2021.644150
10. Patro M, Gothi D, Sah RB, et al. An interesting case of incidental solitary pulmonary nodule. Breathe 2018; 14: e128–e133.
11. Mazzone PJ, Lam L. Evaluating the Patient With a Pulmonary Nodule: A Review. JAMA. 2022; 327(3):264-273. doi: 10.1001/jama.2021.24287.
12. Cruickshank A, Stieler G, Ameer F. Evaluation of the solitary pulmonary nodule. Intern Med J. 2019;49(3):306-315. doi: 10.1111/imj.14219.
13. Zhang, J.; Han, T.; Ren, J.; Jin, C.; Zhang, M.; Guo, Y. Discriminating Small-Sized (2 cm or Less), Noncalcified, Solitary Pulmonary Tuberculoma and Solid Lung Adenocarcinoma in Tuberculosis-Endemic Areas. Diagnostics 2021;11:930. doi.org/10.3390/diagnostics11060930
14. Hosaka N, Kameko M, Nishimura H, Hosaka S. Prevalence of tuberculosis in small pulmonary nodules obtained by video-assisted thoracoscopic surgery. Respir Med. 2006;100(2):238-43. doi: 10.1016/j.rmed.2005.05.004.
15. Kaoutar I, Billah NM, Nassar I. Solitary excavated lung nodule revealing pulmonary tuberculosis: A case report. Int J Case Rep Images 2021;12:101248Z01IK2021.
16. Zeng Y, Zhai XL, Wáng YXJ, Gao WW, Hu CM, Lin FS, Chai WS, Wang JY, Shi YL, Zhou XH, Yu HS, Lu XW. Illustration of a number of atypical computed tomography manifestations of active pulmonary tuberculosis. Quant Imaging Med Surg. 2021;11(4):1651-1667. doi: 10.21037/qims-20-1323.
17. Nèji H, Affes M, Attia M, Ben Saad S, Berraies A, Baccouche I, Hantous-Zannad S, Ben Milad-M'rad K. Atypical Pleuropulmonary Tuberculosis Mimicking a Malignant Disease. J Thorac Oncol. 2017;12(9):e145-e147.
doi: 10.1016/j.jtho.2017.05.003.
18. Kim JY, Jeong YJ, Kim KI, Lee IS, Park HK, Kim YD, Seok I H. Miliary tuberculosis: a comparison of CT findings in HIV-seropositive and HIV-seronegative patients. Br J Radiol. 2010;83(987): 206-11. doi: 10.1259/bjr/95169618.
19. Choi D, Lee KS, Suh GY, Kim TS, Kwon OJ, Rhee CH, Han J. Pulmonary tuberculosis presenting as acute respiratory failure: radiologic findings. J Comput Assist Tomogr. 1999;23(1):107-13. doi: 10.1097/00004728-199901000-00023.
20. Jeong YJ, Lee KS. Pulmonary tuberculosis: up-to-date imaging and management. AJR Am J Roentgenol. 2008;191(3):834-44. doi: 10.2214/AJR.07.3896.
21. Jin SM, Lee HJ, Park EA, Lee HY, Lee SM, Yang SC, Yoo CG, Kim YW, Han SK, Shim YS, Yim JJ. Frequency and predictors of miliary tuberculosis in patients with miliary pulmonary nodules in South Korea: a retrospective cohort study. BMC Infect Dis. 2008;8:160. doi: 10.1186/1471-2334-8-160.
22. Giacomelli IL, Schuhmacher Neto R, Nin CS, Cassano PS, Pereira M, Moreira JDS, Nascimento DZ, Hochhegger B. High-resolution computed tomography findings of pulmonary tuberculosis in lung transplant recipients. J Bras Pneumol. 2017;43(4):270-273. doi: 10.1590/S1806-37562016000000306.
23. Tokuyama Y, Matsumoto T, Kusakabe Y, Yamamoto N, Aihara K, Yamaoka S, Mishima M. Ground-glass opacity as a paradoxical reaction in miliary tuberculosis: A case report and review of the literature. IDCases. 2019;19:e00685. doi: 10.1016/j.idcr.2019.e00685.
24. Nattusamy L, Madan K, Bhalla AS, Guleria R. Reversed halo sign in active pulmonary tuberculosis. BMJ Case Rep. 2014;2014:bcr2013202981. doi: 10.1136/bcr-2013-202981.
25. Zhan X, Zhang L, Wang Z, Jin M, Liu M, Tong Z. Reversed Halo Sign: Presents in Different Pulmonary Diseases. PLoS One. 2015;10(6):e01 28153. doi: 10.1371/journal.pone.0128153.
26. Martini K, Loubet A, Bankier A, Bouam S, Morand P, Cassagnes L, Revel MP, Chassagnon G. Nodular reverse halo sign in active pulmonary tuberculosis: A rare CT feature? Diagn Interv Imaging. 2020;101(5):281-287.
doi: 10.1016/j.diii.2020.01.013.
27. Maturu VN, Agarwal R. Reversed halo sign: a systematic review. Respir Care. 2014;59(9):1440-9. doi: 10.4187/respcare.03020.
28. Marchiori E, Zanetti G, Irion KL, Nobre LF, Hochhegger B, Mançano AD, Escuissato DL. Reversed halo sign in active pulmonary tuberculosis: criteria for differentiation from cryptogenic organizing pneumonia. Am J Roentgenol. 2011;197(6):1324-7. doi: 10.2214/AJR.11.6543.
29. Van LD, Le HN, Pletschette M, Nguyen AT, Nguyen TH, Nguyen NBT. Cystic pulmonary tuberculosis: A rare form of an ancient disease. Respirology Case Reports. 2022;10:e01020. doi.org/10.1002/rcr2.1020
30. Perim J, Pimenta ES, Marchiori E. Cystic tuberculosis: a very unusual aspect of a common disease. Pulmonology. 2020;26(6):400-403. doi: 10.1016/j.pulmoe.2019.12.001.
31. Ray A, Suri JC, Sen MK, Khanna A. Cystic lung disease in tuberculosis: An unusual presentation. Lung India. 2013;30(4):351-3. doi: 10.4103/0970-2113.120620.
32. Ray A, Suri JC, Sen MK, Khanna A. Cystic lung disease in tuberculosis: An unusual presentation. Lung India. 2013;30(4):351-3. doi: 10.4103/0970-2113.120620.
33. Cukic V. The Association Between Lung Carcinoma and Tuberculosis. Med Arch. 2017;71 (3):212-214. doi: 10.5455/medarh.2017.71.212-214.
34. Lee HJ, Goo JM, Im JG. Rapid and irreversible cystic change of pulmonary tuberculosis in an immunocompetent adult. J Thorac Imaging. 2003; 18(4):254-6. doi: 10.1097/00005382-200310000-00009.
35. Kodati R, Tadepalli A, Reddy C. Pulmonary tuberculosis presenting as diffuse cystic lung disease: An atypical manifestation. Indian J Tuberc. 2020;67(3):397-399. doi: 10.1016/j.ijtb.2019.11.016.
36. Hantous-Zannad S, Néji H, Affes M, Attia M, Baccouche I, Kechaou S, Tritar F, Ben Miled-M’rad Kh. Imaging of thoracic tuberculosis. In M. F. Ladeb, W. C. G. Peh (eds.), Imaging of Tuberculosis, Medical Radiology Diagnostic Imaging, https://doi.org/10.1007/978-3-031-07040-2_8
37. Jeon KN, Ha JY, Park MJ, Bae K, Baek HJ, Choi BH, Cho SB, Moon JI, Kim HC. Pulmonary Tuberculosis in Patients With Emphysema: Computed Tomography Findings. J Comput Assist Tomogr. 2016;40(6):912-916.
doi: 10.1097/RCT.0000000000000452.
38. Sershen CL, Salim T and May EE (2023), Investigating the comorbidity of COPD and tuberculosis, a computational study. Front. Syst. Biol. 3:940097.doi: 10.3389/fsysb.2023.940097.
39. Ogawa K, Kurosaki A, Miyamoto A, Takahashi Y, Murase K, Hanada S, Uruga H, Takaya H, Morokawa N, Kishi K. Clinicoradiological Features of Pulmonary Tuberculosis with Interstitial Pneumonia. Intern Med. 2019;58(17):2443-2449. doi: 10.2169/internalmedicine.2341-18.
40. Wong C, Sahni S, Cheema MAI, Iftikhar A. Mycobacterium tuberculosis Infection in the Setting of Interstitial Lung Disease: Coincidence or Bad Luck? Cureus. 2018;10(10):e3391.
doi: 10.7759/cureus.3391.
41. Akhter N, Rizvi NA. Interstitial Lung Diseases Misdiagnosed as Tuberculosis. Pak J Med Sci. 2018; 34(2):338-341. doi: 10.12669/pjms.342.14407.
42. Ehrlich R, Akugizibwe P, Siegfried N, Rees D. The association between silica exposure, silicosis and tuberculosis: a systematic review and meta-analysis. BMC Public Health. 2021;21(1):953. doi: 10.1186/s12889-021-10711-1.
43. Lanzafame M, Vento S. Mini-review: Silico-tuberculosis. J Clin Tuberc Other Mycobact Dis. 2021; 23:100218. doi: 10.1016/j.jctube.2021.100218.
44. Pedroso A, Ferreira I, Chikura T. Tuberculosis and Sarcoidosis Overlap: A Clinical Challenge From Diagnosis to Treatment. Cureus. 2020;12(11):e11662. doi: 10.7759/cureus.11662.
45. Hantous-Zannad S, Zidi A, Néji H, Attia M, Baccouche I, Ben Miled-M'rad K. Apport de l'imagerie dans la tuberculose thoracique [The role of imaging in thoracic tuberculosis]. Rev Pneumol Clin. 2015;71(2-3):93-109.
doi: 10.1016/j.pneumo.2014.02.006.
46. Cabrera-Sanchez J, Cuba V, Vega V, Van der Stuyft P, Otero L. Lung cancer occurrence after an episode of tuberculosis: a systematic review and meta-analysis. Eur Respir Rev. 2022;31(165):220025. doi: 10.1183/16000617.0025-2022.
47. Hwang SY, Kim JY, Lee HS, Lee S, Kim D, Kim S, Hyun JH, Shin JI, Lee KH, Han SH, Song YG. Pulmonary Tuberculosis and Risk of Lung Cancer: A Systematic Review and Meta-Analysis. J Clin Med. 2022;11(3):765. doi: 10.3390/jcm11030765.