Nachiappan Arun C, Rahbar Kasra, Shi Xiao, Guy Elizabeth S, Mortani Barbosa Eduardo J, Shroff Girish S, Ocazionez Daniel, Schlesinger Alan E, Katz Sharyn I, Hammer Mark M
From the Department of Radiology, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Suite 130, Philadelphia, PA 19104 (A.C.N., E.J.M.B., S.I.K., M.M.H.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.R.); Department of Radiology (X.S.) and Department of Medicine, Section of Pulmonary and Critical Care Medicine (E.S.G.), Baylor College of Medicine, Houston, Tex; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.); Department of Diagnostic and Interventional Imaging, University of Texas Medical School at Houston, Houston, Tex (D.O.); and Department of Radiology, Texas Children's Hospital, Houston, Tex (A.E.S.).
Radiographics. 2017 Jan-Feb;37(1):52-72. doi: 10.1148/rg.2017160032.
Tuberculosis is a public health problem worldwide, including in the United States-particularly among immunocompromised patients and other high-risk groups. Tuberculosis manifests in active and latent forms. Active disease can occur as primary tuberculosis, developing shortly after infection, or postprimary tuberculosis, developing after a long period of latent infection. Primary tuberculosis occurs most commonly in children and immunocompromised patients, who present with lymphadenopathy, pulmonary consolidation, and pleural effusion. Postprimary tuberculosis may manifest with cavities, consolidations, and centrilobular nodules. Miliary tuberculosis refers to hematogenously disseminated disease that is more commonly seen in immunocompromised patients, who present with miliary lung nodules and multiorgan involvement. The principal means of testing for active tuberculosis is sputum analysis, including smear, culture, and nucleic acid amplification testing. Imaging findings, particularly the presence of cavitation, can affect treatment decisions, such as the duration of therapy. Latent tuberculosis is an asymptomatic infection that can lead to postprimary tuberculosis in the future. Patients who are suspected of having latent tuberculosis may undergo targeted testing with a tuberculin skin test or interferon-γ release assay. Chest radiographs are used to stratify for risk and to assess for asymptomatic active disease. Sequelae of previous tuberculosis that is now inactive manifest characteristically as fibronodular opacities in the apical and upper lung zones. Stability of radiographic findings for 6 months distinguishes inactive from active disease. Nontuberculous mycobacterial disease can sometimes mimic the findings of active tuberculosis, and laboratory confirmation is required to make the distinction. Familiarity with the imaging, clinical, and laboratory features of tuberculosis is important for diagnosis and management. RSNA, 2017.
结核病是一个全球性的公共卫生问题，在美国也不例外，尤其是在免疫功能低下的患者和其他高危人群中。结核病有活动性和潜伏性两种形式。活动性疾病可表现为原发性结核病，在感染后不久发生，或继发性结核病，在长期潜伏感染后发生。原发性结核病最常见于儿童和免疫功能低下的患者，表现为淋巴结病、肺部实变和胸腔积液。继发性结核病可能表现为空洞、实变和小叶中心结节。粟粒性结核病是指血行播散性疾病，在免疫功能低下的患者中更常见，表现为粟粒性肺结节和多器官受累。检测活动性结核病的主要方法是痰液分析，包括涂片、培养和核酸扩增检测。影像学表现，特别是空洞的存在，会影响治疗决策，如治疗持续时间。潜伏性结核病是一种无症状感染，未来可能导致继发性结核病。疑似患有潜伏性结核病的患者可能会接受结核菌素皮肤试验或干扰素-γ释放试验的针对性检测。胸部X光片用于分层评估风险和评估无症状活动性疾病。既往已治愈的结核病的后遗症典型表现为肺尖和上肺区的纤维结节状阴影。影像学表现6个月稳定可区分非活动性疾病和活动性疾病。非结核分枝杆菌病有时可模仿活动性结核病的表现，需要实验室确诊才能区分。熟悉结核病的影像学、临床和实验室特征对于诊断和管理很重要。RSNA，2017年。
