Tuberc Respir Dis.  2003 Jul;55(1):31-40. 10.4046/trd.2003.55.1.31.

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

• Paeng MH
• Kim YK
• Shim SS
• Chang JH
• Lee JH
• Kwag HJ

• KMID: 1970543
• DOI: http://doi.org/10.4046/trd.2003.55.1.31

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.

Keyword

Lung; CT; Tuberculosis; pulmonary

MeSH Terms

Bronchiectasis
Diagnosis
Diagnosis, Differential
Fever
Humans
Idiopathic Pulmonary Fibrosis
Immunocompromised Host
Leukocytosis
Lung
Lung Diseases
Pneumonia*
Pulmonary Alveolar Proteinosis
Pulmonary Emphysema
Retrospective Studies*
Sputum
Tomography, X-Ray Computed
Tuberculosis
Tuberculosis, Pulmonary*