Effectiveness of radiologic examination methods in diagnosis of pulmonary tuberculosis

Ernesta Rimkevičiūtė, Algidas Basevičius¹, Laima Dobrovolskienė¹, Meida Rimkevičienė¹

Center of Radiology, Vilnius University Hospital Santariškių Klinikos, ¹Clinic of Radiology, Kaunas University of Medicine, Lithuania

Key words: tuberculosis; roentgenography; computed tomography.

Summary. Objective of the study. To determine an optimal noninvasive radiologic examination method (computed tomography or roentgenography) in early diagnostics of pulmonary tuberculosis.

Materials and methods. We have selected 43 patients with diagnosis of pulmonary tuberculosis, who were examined using roentgenography and computed tomography during 2002–2006. Data were confirmed by biopsy or bacteriological test. Evaluation criteria were anamnesis, prolonged cough productive of sputum, prolonged fever, roentgenologic and laboratory findings (lymphocytosis, monocytosis), antibiotic therapy without response.

Results. Diagnostic signs of pulmonary tuberculosis were infiltration (89%), lymphadenopathy (63%), calcification in lymph nodes (49%), pneumofibrosis (56%), focus of tuberculosis (54%), foci in lung segments (67%). Other features were as follows: adhesions, pleural effusion, coated pleura, calcified tuberculoma.

Biopsy was performed to 25% of patients: in 6 patients during fibrobronchoscopy, in 3 during operation, and in 2 during pleural puncture. Fibrobronchoscopy was done in 70% of patients, and findings were as follows: mucus (31%), blood (2%), bronchial deformations (22%), edema of bronchial wall (18%), and no pathology (31%). Only 8% had acid-resistant cocci.

Conclusions. Computed tomography is 2 times more efficient than roentgenography in detection of lung alterations, dissemination with focal infiltration in the bronchioles, coated pleura, pleuritis, adhesions and 8 times more efficient in diagnosis of mediastinal lymphadenopathy. In evaluation of pulmonary consolidation, there was no significance difference between diagnostic methods.

Correspondence to E. Rimkevičiūtė, Center of Radiology, Vilnius University Hospital Santariškių Klinikos, Santariškių 2, 08406 Vilnius, Lithuania. E-mail: ernestarimkeviciute@yahoo.co.uk

Received 8 November 2007, accepted 7 December 2009