Pulmonary Tuberculosis in Patients With Emphysema: Computed Tomography Findings Jeon, Kyung Nyeo MD; Ha, Ji Young MD; Park, Mi Jung MD; Bae, Kyungsoo MD, PhD; Baek, Hye Jin MD; Choi, Bo Hwa MD; Cho, Soo Buem MD; Moon, Jin Il MD; Kim, Ho Cheol MD
Journal of Computer Assisted Tomography: November/December 2016 - Volume 40 - Issue 6 - p 912–916 doi: 10.1097/RCT.0000000000000452 Thoracic Imaging Abstract
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Objective To evaluate the computed tomography (CT) findings and clinical characteristics of pulmonary tuberculosis (TB) in patients with emphysema, compared with those without emphysema. Materials and Methods Thirty-nine patients (M:F = 36:3; mean age, 64.8 years) who were diagnosed with chronic obstructive pulmonary disease and had emphysema in pretreatment chest CT scans were included in this study (emphysema group). Their clinical presentation, laboratory findings, and CT findings were compared with those of 57 pulmonary TB patients without chronic obstructive pulmonary disease and emphysema (M:F = 52:5; mean age, 64.3 years) (nonemphysema group). Results Fever was a more frequent clinical presentation and the C-reactive protein level was higher in the emphysema group. Among CT findings, consolidation and ground-glass opacity were seen more frequently in the emphysema group (82% and 69% vs 42% and 19%, respectively, P < 0.001). Consolidation was more often nonsegmental than lobular or segmental. Tree-in-bud appearance was less frequently noted in the emphysema group (36% vs 79%, P < 0.001). The location of main lesions (upper lung vs middle/lower lung) was not different between the 2 groups. Conclusions Pulmonary TB in emphysema patients often shows bacterial pneumonia-like features, that is, presence of consolidation and ground-glass opacity and lack of bronchogenic spread on chest CT scans, combined with the presence of fever and a high C-reactive protein level. Sputum smear for acid-fast bacteria should be performed early in emphysema patients with pneumonia in TB-endemic areas. From the *Department of Radiology, Gyeongsang National University School of Medicine, Jinju; †Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon; ‡Department of Radiology, Gyeongsang National University Hospital, Jinju; and § Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea. Received for publication March 20, 2016; accepted April 15, 2016. Correspondence to: Kyungsoo Bae, MD, PhD, Gyeongsang National University School of Medicine, Department of Radiology, Gyeongsang National University Changwon Hospital 555 Samjeongja-dong, Seongsan-gu, Changwon, 51472, Korea (e-mail:
[email protected],
[email protected]). The authors declare no conflict of interest. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.