Contribution of imaging in the management of resistant tuberculosis

Resistant tuberculosis is a topical subject given the difficulties of its management.

To evaluate the role of imaging in the diagnosis and follow-up of multidrug-resistant tuberculosis (MDR-TB).

Retrospective study of MDR-TB cases followed in Hall C of Abderrahmane Mami Hospital (2010 to 2016).

Forty four patients included. The average age was 33 (15-58). The sex ratio was 1.7. Chest radiographs at the start of treatment showed lesions dominated by nodules (n = 39) and cavities (n = 36). The parenchymal lesions were bilateral (n = 32), associated pleural (n = 4) and mediastinal lesions (n = 7). During treatment, radiological improvement dominated during the first 7 months of treatment. Computed tomography was performed as part of the preoperative assessment of MDR-TB (n = 2), lung cancer extension assessment (n = 1) and etiological assessment of haemoptysis. It allowed to refute a suspected pulmonary embolism (n = 1) and to drain a pleural effusion. Parenchymal lesions on CT were dominated by nodules (n = 8) and cavities (n = 6). Mediastinal nodes (n = 4) and pleural effusions (n = 3) were noted. Ultrasonography showed pleural effusion with pleural thickening (n = 2) and permits its ponction.

Imaging is a key element in the diagnostic approach to tuberculosis. It permits to evaluate tuberculous lesions and to detect tuberculous complications. It helps to guide the therapeutic management and evaluate its effectiveness.