CT of pulmonary tuberculosis

CT scans in patients with primary tuberculosis commonly show lymphohematogenous spread of the disease, whereas those of postprimary (reactivation) tuberculosis commonly show bronchogenic spread. High-resolution CT (HCRT) is extremely helpful in understanding pathomorphological changes, mode of spread of the disease, and sequential morphological change after antituberculous chemotherapy, and possibly in diagnosing activity of the disease. Centrilobular 2- to 4-mm nodules or branching linear lesions representing intrabronchiolar and peribronchiolar caseation necrosis are the most common findings of early bronchogenic spread of tuberculosis. The 2- to 4-mm centrilobular nodules may coalesce to form 5- to 8-mm nodules or lobular consolidation. Cavitation usually begins at the central portion of a lobule around the bronchioles. Resolution of the tuberculous lesions occurs with antituberculous chemotherapy, resulting in varying degrees of fibrosis, bronchovascular distortion, emphysema, and bronchiectasis. HRCT may show both paracicatricial irregular emphysema and lobular emphysema. CT findings of early miliary dissemination commonly include ground-glass opacification with barely discernible nodules that show discrete miliary nodules thereafter. CT also is useful in the evaluation of long-standing destructive pulmonary lesions and tracheobronchial tuberculosis.