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Unusual radiographic findings in adult pulmonary tuberculosis
Abstract:
To determine the frequency of unusual chest radiographic findings in adults (older than 15 years) with pulmonary tuberculosis, charts and radiographs of 270 consecutive cases seen in a 12 month period were reviewed. Radiographic findings not typical of primary or postprimary disease (reinfection) were arbitrarily classified as unusual. The incidence of such findings (8%) was considerably lower than in several recent reports (25%, 29%). Likewise, the incidence of lower lobe tuberculosis in diabetics in this population (8.3%) was lower than in a report by Weaver (20%), and the finding of air-fluid levels in patients with cavitary disease (9%) was lower than a report by Cohen (22%). Possible explanations for these discrepancies were reviewed, including: (1) demographic characteristics, (2) the patient selection process, (3) the arbitrary nature of any system of classification of "unusual" findings, and (4) the change in the epidemiology of the disease as a result of chemotherapy and organized eradication programs. Of these, the patient selection process is probably the most significant factor in the discrepancy between the incidence of unusual findings in this series compared with those reported by others.
Insights
This study found a lower incidence of unusual chest X-ray findings in pulmonary tuberculosis patients compared to previous reports. Patient selection processes may explain these differences in tuberculosis presentation.
Area of Science:
- Radiology
- Pulmonology
- Infectious Diseases
Background:
- Pulmonary tuberculosis (TB) diagnosis often relies on chest radiography.
- Unusual radiographic findings can indicate atypical disease presentations or specific patient populations.
- Previous studies reported varying incidences of unusual findings in TB patients.
Purpose of the Study:
- To determine the frequency of unusual chest radiographic findings in adults with pulmonary tuberculosis.
- To compare these findings with previously published data.
- To explore potential reasons for observed discrepancies.
Main Methods:
- Retrospective review of charts and radiographs from 270 consecutive adult pulmonary tuberculosis cases over 12 months.
- Classification of radiographic findings not typical of primary or postprimary (reinfection) TB as unusual.
- Comparison of incidence rates with existing literature.
Main Results:
- The incidence of unusual chest radiographic findings was 8%, significantly lower than reported in recent studies (25%, 29%).
- Lower lobe tuberculosis in diabetics occurred at 8.3%, lower than a previous report (20%).
- Air-fluid levels in cavitary disease were found in 9% of cases, lower than another report (22%).
Conclusions:
- The incidence of unusual radiographic findings in pulmonary tuberculosis is lower in this series compared to previous reports.
- Patient selection processes are likely the most significant factor contributing to these discrepancies.
- Other factors like demographics, classification subjectivity, and TB epidemiology changes may also play a role.