Korean J Radiol.  2009 Jun;10(3):207-216. 10.3348/kjr.2009.10.3.207.

Radiological Findings of Extensively Drug-Resistant Pulmonary Tuberculosis in Non-AIDS Adults: Comparisons with Findings of Multidrug-Resistant and Drug-Sensitive Tuberculosis

• Cha J
• Lee HY
• Lee KS
• Koh WJ
• Kwon OJ
• Yi CA
• Kim TS
• Chung MJ

• KMID: 1779447
• DOI: http://doi.org/10.3348/kjr.2009.10.3.207

Abstract

OBJECTIVE
This study was designed to describe the radiological findings of extensively drug-resistant (XDR) pulmonary tuberculosis (TB) and to compare the observed findings with findings of drug-sensitive (DS) and non-XDR multidrug-resistant (MDR) TB in non-AIDS patients. MATERIALS AND METHODS: From September 1994 to December 2007, 53 MDR TB patients (M:F = 32:21; mean age, 38 years) and 15 XDR TB non-AIDS patients (M:F = 8:7; mean age, 36 years) were enrolled in the study. All of the MDR TB patients had received no treatment or less than one month of anti-TB treatment. In addition, all XDR TB patients received either no anti-TB treatment or only first-line anti-TB drugs. In addition, 141 consecutive DS TB patients (M:F = 79:62; mean age, 51 years) were also enrolled in the study for comparison. Chest radiograph, CT and demographic findings were reviewed and were compared among the three patient groups. RESULTS: For patients with XDR TB, the most frequent radiographic abnormalities were nodules (15 of 15 patients, 100%), reticulo-nodular densities (11 of 15, 73%), consolidation (9 of 15, 60%) and cavities (7 of 15, 47%) that were located mainly in the upper and middle lung zones. As seen on radiographs, significant differences were found for the frequency of nodules and ground-glass opacity lesions (all p < 0.001) (more frequent in DS TB patients than in MDR and XDR TB patients). For the use of CT, significant differences (more frequent in MDR and XDR TB patients) were found for the frequency of multiple cavities, nodules and bronchial dilatation (p = 0.001 or p < 0.001). Patients with MDR TB and XDR TB were younger as compared to patients with DS TB (p < 0.001). Imaging findings were not different between patients with MDR TB and XDR TB. CONCLUSION: By observation of multiple cavities, nodules and bronchial dilatation as depicted on CT in young patients with acid-fast bacilli (AFB) positive sputum, the presence of MDR TB or XDR TB rather than DS TB can be suggested. There is no significant difference in imaging findings between patients with XDR TB and MDR TB.

Keyword

Computed tomography (CT), high-resolution; Lung, infection; Tuberculosis, pulmonary; Thorax, radiography

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Drug Resistance, Bacterial
Drug Resistance, Multiple, Bacterial
Female
Humans
Image Processing, Computer-Assisted/methods
Lung/drug effects/radiography
Male
Middle Aged
Observer Variation
Retrospective Studies
Tomography, X-Ray Computed/methods
Tuberculosis, Multidrug-Resistant/*radiography
Tuberculosis, Pulmonary/*drug therapy/*radiography
Young Adult

Figure

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  Fig. 1 Findings for extensively drug-resistant pulmonary tuberculosis in 29-year-old man. Posterior-anterior chest radiograph shows nodules, consolidation containing cavities and ground-glass opacity in right lung and reticulo-nodular lesions (arrow) in left middle lung zone.

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  Fig. 2 Findings for extensively drug-resistant pulmonary tuberculosis in 22-year-old man. A. Posterior-anterior chest radiograph shows small nodular lesions, reticulo-nodular lesions and cavitating nodules (arrows) mainly in left upper and middle lung zones and in right apex. B-D. Transverse CT (2.5-mm section thickness) scans obtained at levels of great vessels (B), main bronchi (C) and left basal trunk (D), respectively, show small nodules and cavitating nodules (arrows) mainly in left upper lobe and superior segment of left lower lobe. Also, note mild interlobular septal thickening (arrowheads) in left upper lobe.

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  Fig. 3 Findings for drug-sensitive tuberculosis in 70-year-old man. A. Posterior-anterior chest radiograph shows small nodular lesions (small arrows) in right upper lung zone and variable-sized nodules and reticulo-nodular lesions (large arrows) in right lower lung zone. B-D. Transverse CT (2.5-mm section thickness) scans obtained at levels of great vessels (B), aortic arch (C) and liver dome (D), respectively, show small nodules (arrows), tree-in-bud signs (arrowheads) and nodules (curved arrow) in right upper lobe and right lower lobe.

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