Chest radiographs and TB Graham Bothamley Jean-Paul Zellweger

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<ul><li>Slide 1</li></ul> <p> Slide 2 Chest radiographs and TB Graham Bothamley Jean-Paul Zellweger Slide 3 Plan of session 1.The typical chest x-ray of TB 2.Atypical chest x-rays 3.Extrapulmonary TB on the chest x-ray 4.Inactive tuberculosis 5.The normal chest x-ray with C+PTB 6.Differential diagnoses Slide 4 What are the typical features of tuberculosis on a chest x-ray? Slide 5 Chest x-rays StudyUnder-reading % of positives Over-reading % of negatives 5 experts25- General271.7 Mass radiography321.7 Danish mass radiography321.6 Reader panel (15,000)391.2 10 best radiologists210.5 10 best physicians260.3 Average322 Improvement only if &gt;20,000 films read annually. Nakamura et al. Kekkaku 1970; 45:121 Slide 6 Conclusions from mass x-ray surveys Sudden, symptomatic onset as common as insidious onset Disease extent unrelated to duration (extensive S+PTB within first 3-6 m) Cavitation is not a late occurrence its frequency is nearly the same at all temporal stages of the disease Toman. Case finding and chemotherapy. WHO, Geneva, 1979 Slide 7 Atypical TB Lower zone No cavitation (miliary) Slide 8 Atypical TB Female Diabetes HIV Elderly Slide 9 Extrapulmonary TB Mediastinal lymph nodes Pleural effusions Paraspinal abscess Spinal disease Slide 10 Pleural effusion Slide 11 Pericardial TB Slide 12 TB of the spine Slide 13 Inactive or self-healed tuberculosis Primary focus/calcified granuloma Coin lesion Fibrosis Slide 14 Slide 15 The normal chest radiograph with a positive M.tb culture Single isolate or repeated? Lab contamination strain typing CT scan Treat? Slide 16 Differential diagnosis Non-tuberculous mycobacterial disease Sarcoidosis Fungal disease Slide 17 Slide 18 M. xenopi Slide 19 Slide 20 NTMD Background of COPD Thicker pleural reaction Slide 21 Slide 22 M. fortuitum Slide 23 Slide 24 Slide 25 Slide 26 Bronchiectasis Tree in bud Nodules Slide 27 Slide 28 Mycobacterium spp. Runyon group III Slide 29 The Quiz Estimate the probability of the diagnosis of tuberculosis and indicate whether you think the person will be sputum smear-positive Read the histories and estimate a prior probability of TB Look at the CXRs again in a different order this time and again estimate the probability of TB and whether the sputum smear will be positive Slide 30 Exercise: 20 CXRs Estimate the probability of TB Slide 31 1 Slide 32 2 Slide 33 3 Slide 34 4 Slide 35 5 Slide 36 6 Slide 37 7 Slide 38 8 Slide 39 9 Slide 40 10 Slide 41 11 Slide 42 12 Slide 43 13 Slide 44 14 Slide 45 15 Slide 46 16 Slide 47 17 Slide 48 18 Slide 49 19 Slide 50 20 </p>