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CT Scan Differences of Pulmonary TB According to Presence of Pleural Effusion
Min Kyung Jung1, Sang Young Lee1, Eun Jeong Min2
1Department of Radiology St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Background:
Subpleural micronodules and interlobular septal thickening are common CT scan findings in TB pleural effusion. These CT scan features could help us differentiate between TB pleural effusion and nonTB empyema.
Research Question:
Does the frequency of subpleural micronodules and interlobular septal thickening correlate with the presence of pleural effusion in patients with pulmonary TB?
Study Design And Methods:
CT scan findings of pulmonary TB, micronodules and their distribution (peribronchovascular, septal, subpleural, centrilobular, and random), large opacity (consolidation/macronodule), cavitation, tree-in-buds, bronchovascular bundle thickening, interlobular septal thickening, lymphadenopathy, and pleural effusion were retrospectively analyzed. Patients were divided into two groups according to the presence of pleural effusion. Clinicoradiologic findings of the two groups were then analyzed. We presented Benjamini-Hochberg critical value for multiple testing correction of CT scan findings, with a false discovery rate of 0.05.
Results:
Of a total of 338 consecutive patients diagnosed with pulmonary TB who underwent CT scans, 60 were excluded because of coexisting pulmonary diseases. The frequency of subpleural nodules (47/68, 69% in pulmonary TB with pleural effusion vs 30/210, 14% in pulmonary TB without effusion, P < .001, Benjamini-Hochberg [B-H] critical value = 0.0036) and interlobular septal thickening (55/68, 81% vs 134/210, 64%, P = .009, B-H critical value = 0.0107) was significantly higher in the group of patients with pulmonary TB with pleural effusion than in the group without pleural effusion. In contrast, tree-in-buds (20/68, 29% vs 101/210, 48%, P = .007, B-H critical value = 0.0071) were less frequently seen in patients with pulmonary TB with pleural effusion.
Interpretation:
Subpleural nodules and septal thickening were more common in pulmonary TB patients with pleural effusion than in those without pleural effusion. TB involvement of the lymphatics in the peripheral interstitium could be associated with the development of pleural effusion.
Insights
Subpleural nodules and interlobular septal thickening on CT scans are more frequent in patients with tuberculosis pleural effusion. These findings aid in differentiating TB pleural effusion from non-TB empyema.
Area of Science:
- Radiology
- Pulmonology
- Infectious Diseases
Background:
- Tuberculosis (TB) pleural effusion diagnosis can be challenging.
- Subpleural micronodules and interlobular septal thickening are recognized CT scan findings in TB pleural effusion.
- These features may help distinguish TB pleural effusion from non-TB empyema.
Purpose of the Study:
- To investigate the correlation between subpleural micronodules, interlobular septal thickening, and the presence of pleural effusion in patients with pulmonary TB.
- To assess the diagnostic utility of these CT findings in differentiating TB pleural effusion.
Main Methods:
- Retrospective analysis of CT scan findings in 338 patients with pulmonary TB.
- Patients were categorized into groups with and without pleural effusion.
- Clinicoradiologic findings were compared, with statistical analysis using Benjamini-Hochberg correction.
Main Results:
- Subpleural nodules were significantly more frequent in patients with TB pleural effusion (69%) compared to those without (14%) (P < .001).
- Interlobular septal thickening was also more common in the pleural effusion group (81%) versus the non-effusion group (64%) (P = .009).
- Tree-in-buds pattern was less frequent in patients with TB pleural effusion (29%) than in those without (48%) (P = .007).
Conclusions:
- Subpleural nodules and interlobular septal thickening are significantly associated with pleural effusion in pulmonary TB patients.
- These CT findings may indicate TB involvement of peripheral lymphatic vessels, contributing to effusion development.
- CT imaging can aid in differentiating TB pleural effusion from non-TB empyema.
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