Radiological patterns of pulmonary tuberculosis in Nigeria

Two hundred and sixteen patients with pulmonary tuberculosis were reviewed. Childhood and adult patterns of tuberculosis as noted in other countries were recognised. However, some children were seen with an adult pattern most probably due to a reinfection. There were also adults with the childhood pattern most probably due to a failure in the localisation of the primary intra-pulmonary parenchymal lesions with subsequent haematogenous spread. The prognosis in children with the adult pattern, and in adults with the childhood pattern was poor. The lesions (noted in this study) were severe and widespread, and with a high incidence of complications such as adenopathy and exudative lesions. The high incidence of associated diseases such as measles and malnutrition would account for the severity of tuberculosis and the high percentage of negative tuberculin tests in these patients. No lobes were exempted from involvement. But the upper lobes especially the right were the most affected. Negative tuberculosis tests make repeated sputa examinations imperative in the diagnosis of tuberculosis in this environment. The high predominance of male patients among those with miliary tuberculosis in our study remains unexplained. The genotype distribution amongst our patients shows no statistical difference between them and that of the population.