Tuberculosis radiology

Radiology (X-rays) is used in the diagnosis of tuberculosis. Abnormalities on chest radiographs may be suggestive of, but are never diagnostic of, TB but can be used to rule out pulmonary TB.

A posterior-anterior (PA) chest X-ray is the standard view used; other views (lateral or lordotic) or CT scans may be necessary.

In active pulmonary TB, infiltrates or consolidations and/or cavities are often seen in the upper lungs with or without mediastinal or hilar lymphadenopathy. However, lesions may appear anywhere in the lungs. In HIV and other immunosuppressed persons, any abnormality may indicate TB or the chest X-ray may even appear entirely normal.

Old healed tuberculosis usually presents as pulmonary nodules in the hilar area or upper lobes, with or without fibrotic scars and volume loss.Bronchiectasis and pleural scarring may be present.

Nodules and fibrotic scars may contain slowly multiplying tubercle bacilli with the potential for future progression to active tuberculosis. Persons with these findings, if they have a positive tuberculin skin test reaction, should be considered high-priority candidates for treatment of latent infection regardless of age. Conversely, calcified nodular lesions (calcified granuloma) pose a very low risk for future progression to active tuberculosis.

Abnormalities on chest radiographs may be suggestive of, but are never diagnostic of, TB. However, chest radiographs may be used to rule out the possibility of pulmonary TB in a person who has a positive reaction to the tuberculin skin test and no symptoms of disease.

A medical examination is mandatory for all refugees coming to the U.S. and all applicants outside the U.S. applying for an immigrant visa. The purpose of the medical examination is to identify applicants with inadmissible health-related conditions such as active tuberculosis. Outside the U.S., medical examinations are performed by approximately 400 physicians (panel physicians) selected by United States Department of State consular officials. In the U.S., medical examinations are performed by approximately 3,000 physicians (civil surgeons) designated by district directors of the U.S. Citizenship and Immigration Services. Guidelines were developed by the Centers for Disease Control and Prevention (CDC).

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