Chest X-ray findings in relation to gender and symptoms: a study of patients with smear positive tuberculosis in Vietnam.

The aim of the study was to analyse chest X-ray (CXR) findings among men and women with smear positive pulmonary tuberculosis (TB). All new cases of smear positive pulmonary TB diagnosed during 6 months in 23 districts in Vietnam were included in a cross-sectional study. 366 cases fulfilled the inclusion criteria. Pleuritis was demonstrated in 17% of the men's CXR versus 3% of the women's, p = 0.002. A miliary pattern was seen in 11% of the men's CXR versus 3% of the women's, p = 0.04. Hilar adenopathy was common and equally distributed among men and women (65% vs 61%). Dyspnoea was common among patients with pleuritis (67%) and a miliary pattern (65%). The radiological findings were more advanced in men than women, despite a similar time from symptom onset to diagnosis. The primary manifestations of TB found among men were unexpected in this setting with an HIV prevalence <0.1% at the time. The association with other risk factors for TB in men needs further investigation. The less advanced CXR findings in women may correspond to a slower rate of progression to smear positive disease, which would have implications for the possibilities of women to obtain a timely TB diagnosis.