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Chest Imaging

E2643. Tuberculosis From Head to Toe: A Pictorial Review

Riley K,  Tahir B. Indiana University School of Medicine, Indianapolis, IN

Address correspondence to K. Riley (riley9@iupui.edu)

Background Information: Tuberculosis is now the leading infectious cause of death worldwide. Although less common in the United States, there were still more than 9,000 reported cases in 2014. Tuberculosis bacilli establish infection in humans within the lungs, with pulmonary disease being the most commonly seen manifestation, which is often demonstrated on chest radiography and CT. Lymphatic spread and hematogenous dissemination of tuberculosis bacilli are well-characterized phenomena, and tuberculosis has been described in every area of the body. Although pulmonary disease is the most commonly seen manifestation of tuberculosis, in the United States, more than one-fifth of the reported cases did not include any pulmonary involvement.

Educational Goals/Teaching Points: The goal of this exhibit is to familiarize the reader with both classic and atypical features of tuberculosis through a multimodality review of these imaging manifestations throughout the body.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: In addition to the classic pulmonary findings seen on radiography and CT, tuberculosis can present nearly anywhere else in the body and be demonstrated on multiple other imaging modalities. CT may reveal tuberculous spread to multiple extrapulmonary organs, including the liver, kidneys and ureters, lymph nodes (scrofula), and peritoneum. MRI may reveal tuberculous osteomyelitis of the axial and appendicular skeleton along with brain and meningeal involvement. The sequelae of genitourinary disease including epididymitis and chronic pyelonephritis may be visualized using ultrasound.

Conclusion: In this exhibit, we present multiple images from these various imaging modalities illustrating both classic and unusual manifestations of tuberculosis disease. Familiarity with these common and uncommon imaging features of tuberculosis play a critical role in the diagnosis of the disease, particularly in those patients presenting with no pulmonary disease features.