Abstract:

Objective To investigate the value of diagnosis and differential diagnosis in pulmonary tuberculosis patients with cluster-like micronodular lesions in chest CT imaging. Methods A retrospective analysis was performed in 74 patients with cluster-like micronodule confirmed by CT from January 2016 to August 2019 in Beijing Chest Hospital including 70 patients diagnosed as active tuberculosis by clinical or laboratory examination, two cases diagnosed as non-specific inflammation and two cases diagnosed as sarcoidosis. This study focused on the CT scan features in 70 patients diagnosed as pulmonary tuberculosis including the distribution of cluster-like micronodular lesions, distribution patterns, morphological features, and CT signs of other morphologic lesions coexisting in the lungs Results The CT scan of 70 patients with pulmonary tuberculosis showed that cluster-like micronodular lesions were distributed in the apicoposterior segment of the upper lobe in both lungs in 49 (70.0%) cases and multiple nodules in 49 (70.0%) cases. The image features showed in four patterns: homogenous pattern (47.1%,33/70), halo pattern (25.7%,18/70), reversed halo pattern (18.6%,13/70) and mixed pattern (8.6%,6/70). There were 29 cases (41.4%) with uniform nodule size and 41 cases (58.6%) with different sizes which partial focus were fused. Except the cluster-like micronodular lesions, in other parts of lung there were coexisting one morphology lesions showing consolidation-like shadows, cavities, nodular-like lesions or fibrous cord-like lesions in 10 cases (14.3%), two kinds of the forms (as above)in 15 cases (21.4%),three kinds of the forms (as above) in 16 cases (22.9%) and four kinds of the forms (as above) in 6 cases (8.6%). Mediastinal and/or hilar lymphadenopathy occurred in 14 cases (20.0%). There were pleural effusion in 9 cases (12.9%). Sarcoidosis and non-specific inflammation also showed cluster-like micronodular lesions in each two cases which were similar to the imaging features of pulmonary tuberculosis. Conclusion CT scans show cluster-like micronodular lesions, whether single localization or multiple distribution, they should be considered as a more common and atypical form of secondary tuberculosis. It should be paid more attention in practice.

Key words: Tuberculosis, pulmonary, Tomography, X-ray computed, Diagnostic imaging, Disease attributes, Diagnosis, differential