ABSTRACT
Tuberculosis (TB) in primary infection commonly manifests as hilar and mediastinal lymphadenopathy, pleural effusion, and parenchymal consolidation, whereas post-primary (reactivation) TB is characterized by upper-zone-predominant consolidation, cavitation, and endobronchial spread. Accurate radiologic assessment of pulmonary, pleural, and mediastinal involvement, primarily with chest radiography and computed tomography, is critical for diagnosis, staging, and treatment planning. This review summarizes the characteristic imaging features of pulmonary, pleural, and mediastinal TB, highlights key points in the differential diagnosis, and discusses the role of imaging in recognizing disease-related complications within a systematic radiologic framework.
Keywords:
Pulmonary tuberculosis, pleural tuberculosis, mediastinal tuberculosis, radiologic imaging, chest radiography, computed tomography
References
1
Jeong YJ, Lee KS. Pulmonary tuberculosis: up-to-date imaging and management. AJR Am J Roentgenol. 2008; 191: 834-44.
2
Nachiappan AC, Rahbar K, Shi X, Guy ES, Mortani Barbosa EJ Jr, Shroff GS, et al. Pulmonary tuberculosis: role of radiology in diagnosis and management. Radiographics. 2017; 37: 52-72.
3
Semionov A, Lebel K, Diouf A, Pressacco J. Tuberculosis: a head-to-toe radiological review. Open J Radiol. 2022; 12: 207-21.
4
Burrill J, Williams CJ, Bain G, Conder G, Hine AL, Misra RR. Tuberculosis: a radiologic review. Radiographics. 2007; 27: 1255-73.
5
Rai DK, Kirti R, Kumar S, Karmakar S, Thakur S. Radiological difference between new sputum-positive and sputum-negative pulmonary tuberculosis. J Family Med Prim Care. 2019; 8: 2810-3.
6
Schneider E, Moore M, Castro KG. Epidemiology of tuberculosis in the United States. Clin Chest Med. 2005; 26: 183-95.
7
Maher D, Raviglione M. Global epidemiology of tuberculosis. Clin Chest Med. 2005; 26: 167-82, v.
8
McAdams HP, Erasmus J, Winter JA. Radiologic manifestations of pulmonary tuberculosis. Radiol Clin North Am. 1995; 33: 655-78.
9
Harisinghani MG, McLoud TC, Shepard JA, Ko JP, Shroff MM, Mueller PR. Tuberculosis from head to toe. Radiographics. 2000; 20: 449-70; quiz 528-9, 32.
10
Morbee L, Gosselin R. Imaging of pulmonary tuberculosis made easy. J Belg Soc Radiol. 2024; 108: 102.
11
Valdés L, Alvarez D, San José E, Penela P, Valle JM, García-Pazos JM, et al. Tuberculous pleurisy: a study of 254 patients. Arch Intern Med. 1998; 158: 2017-21.
12
Gopi A, Madhavan SM, Sharma SK, Sahn SA. Diagnosis and treatment of tuberculous pleural effusion in 2006. Chest. 2007; 131: 880-9.
13
Curvo-Semedo L, Teixeira L, Caseiro-Alves F. Tuberculosis of the chest. Eur J Radiol. 2005; 55: 158-72.
14
Hulnick DH, Naidich DP, McCauley DI. Pleural tuberculosis evaluated by computed tomography. Radiology. 1983;149:759-65.
15
Leung AN, Müller NL, Pineda PR, FitzGerald JM. Primary tuberculosis in childhood: radiographic manifestations. Radiology. 1992; 182: 87-91.
16
Leung AN. Pulmonary tuberculosis: the essentials. Radiology. 1999; 210: 307-22.
17
Moon WK, Im JG, Yeon KM, Han MC. Mediastinal tuberculous lymphadenitis: CT findings of active and inactive disease. AJR Am J Roentgenol. 1998; 170: 715-8.
18
Goodwin RA, Des Prez RM. Apical localization of pulmonary tuberculosis, chronic pulmonary histoplasmosis, and progressive massive fibrosis of the lung. Chest. 1983; 83: 801-5.
19
Im JG, Itoh H, Shim YS, Lee JH, Ahn J, Han MC, et al. Pulmonary tuberculosis: CT findings--early active disease and sequential change with antituberculous therapy. Radiology. 1993; 186: 653-60.
20
Calpe JL, Chiner E, Larramendi CH. Endobronchial tuberculosis in HIV-infected patients. AIDS. 1995; 9: 1159-64.
21
Lee KS, Kim YH, Kim WS, Hwang SH, Kim PN, Lee BH. Endobronchial tuberculosis: CT features. J Comput Assist Tomogr. 1991; 15: 424-8.
22
Collins J, Blankenbaker D, Stern EJ. CT patterns of bronchiolar disease: what is “tree-in-bud”? AJR Am J Roentgenol. 1998; 171: 365-70.
23
Krysl J, Korzeniewska-Kosela M, Müller NL, FitzGerald JM. Radiologic features of pulmonary tuberculosis: an assessment of 188 cases. Can Assoc Radiol J. 1994; 45: 101-7.
24
SOCHOCKY S. Tuberculoma of the lung. Am Rev Tuberc. 1958; 78: 403-10.
25
Goo JM, Im JG, Do KH, Yeo JS, Seo JB, Kim HY, et al. Pulmonary tuberculoma evaluated by means of FDG PET: findings in 10 cases. Radiology. 2000; 216: 117-21.
26
Hara T, Kosaka N, Suzuki T, Kudo K, Niino H. Uptake rates of 18F-fluorodeoxyglucose and 11C-choline in lung cancer and pulmonary tuberculosis: a positron emission tomography study. Chest. 2003; 124: 893-901. https://doi.org/10.1378/chest.124.3.893
27
Marchiori E, Zanetti G, Irion KL, Nobre LF, Hochhegger B, Mançano AD, et al. Reversed halo sign in active pulmonary tuberculosis: criteria for differentiation from cryptogenic organizing pneumonia. AJR Am J Roentgenol. 2011; 197: 1324-7.
28
Lee KS, Im JG. CT in adults with tuberculosis of the chest: characteristic findings and role in management. AJR Am J Roentgenol. 1995; 164: 1361-7.
29
Moon WK, Im JG, Yeon KM, Han MC. Tuberculosis of the central airways: CT findings of active and fibrotic disease. AJR Am J Roentgenol. 1997; 169: 649-53.
30
Kim Y, Lee KS, Yoon JH, Chung MP, Kim H, Kwon OJ, et al. Tuberculosis of the trachea and main bronchi: CT findings in 17 patients. AJR Am J Roentgenol. 1997; 168: 1051-6.
31
Adler BD, Padley SP, Müller NL. Tuberculosis of the chest wall: CT findings. J Comput Assist Tomogr. 1993; 17: 271-3.
32
Lee G, Im JG, Kim JS, Kang HS, Han MC. Tuberculosis of the ribs: CT appearance. J Comput Assist Tomogr. 1993; 17: 363-6.
33
Winer-Muram HT, Rubin SA. Thoracic complications of tuberculosis. J Thorac Imaging. 1990; 5: 46-63.
34
Shepherd MP. Plombage in the 1980s. Thorax. 1985; 40: 328-40.
35
Verschakelen JA, De Wever W. Computed Tomography of the Lung. A pattern approach. In: Kauczor HU, Parizel PM, Peh WCG. Heidelberg: Springer; 2018. p.81-101
36
Sun J, Weng D, Jin C, Yan B, Xu G, Jin B, et al. The value of high resolution computed tomography in the diagnostics of small opacities and complications of silicosis in mine machinery manufacturing workers, compared to radiography. J Occup Health. 2008; 50: 400-5.
37
Im JG, Itoh H. Tree-in-bud pattern of pulmonary tuberculosis on thin-section CT: pathological ımplications. Korean J Radiol. 2018; 19: 859-65.
38
Nin CS, de Souza VV, do Amaral RH, Schuhmacher Neto R, Alves GR, Marchiori E, et al. Thoracic lymphadenopathy in benign diseases: a state of the art review. Respir Med. 2016; 112: 10-7.
39
Diagnostic standards and classification of tuberculosis in adults and children. This official statement of the American Thoracic Society and the Centers for Disease Control and Prevention was adopted by the ATS Board of Directors, July 1999. This statement was endorsed by the Council of the Infectious Disease Society of America, September 1999. Am J Respir Crit Care Med. 2000; 161: 1376-95.
40
Grzybowski S, Fishaut H, Rowe J, Brown A. Tuberculosis among patients with various radiologic abnormalities, followed by the chest clinic service. Am Rev Respir Dis. 1971; 104: 605-8.
41
Ikezoe J, Takeuchi N, Johkoh T, Kohno N, Tomiyama N, Kozuka T, et al. CT appearance of pulmonary tuberculosis in diabetic and immunocompromised patients: comparison with patients who had no underlying disease. AJR Am J Roentgenol. 1992; 159: 1175-9.
42
Girardi E, Antonucci G, Vanacore P, Palmieri F, Matteelli A, Iemoli E, et al. Tuberculosis in HIV-infected persons in the context of wide availability of highly active antiretroviral therapy. Eur Respir J. 2004; 24: 11-7.
43
Aaron L, Saadoun D, Calatroni I, Launay O, Mémain N, Vincent V, et al. Tuberculosis in HIV-infected patients: a comprehensive review. Clin Microbiol Infect. 2004; 10: 388-98.
44
Shelburne SA 3rd, Hamill RJ. The immune reconstitution inflammatory syndrome. AIDS Rev. 2003; 5: 67-79.
45
Murray JF, Mills J. Pulmonary infectious complications of human immunodeficiency virus infection. Part I. Am Rev Respir Dis. 1990; 141: 1356-72.
46
Barnes PF, Le HQ, Davidson PT. Tuberculosis in patients with HIV infection. Med Clin North Am. 1993; 77: 1369-90.
47
Goodman PC. Pulmonary tuberculosis in patients with acquired immunodeficiency syndrome. J Thorac Imaging. 1990; 5: 38-45.
48
Stop TB Partnership. Childhood TB Subgroup. Guidance for national TB programmes on childhood TB. Int J Tuberc Lung Dis. 2006; 10: 1091-97.
49
Cruz AT, Hwang KM, Birnbaum GD, Starke JR. Adolescents with tuberculosis: a review of 145 cases. Pediatr Infect Dis J. 2013; 32: 937-41.
50
CDC. TB in children. (2025).
51
Lee KS, Song KS, Lim TH, Kim PN, Kim IY, Lee BH. Adult-onset pulmonary tuberculosis: findings on chest radiographs and CT scans. AJR Am J Roentgenol. 1993; 160: 753-8.
52
Hunter RL. The Pathogenesis of Tuberculosis: The early infiltrate of post-primary (adult pulmonary) tuberculosis: a distinct disease entity. Front Immunol. 2018; 9: 2108.
53
Concepcion NDP, Laya BF, Andronikou S, Abdul Manaf Z, Atienza MIM, Sodhi KS. Imaging recommendations and algorithms for pediatric tuberculosis: part 1-thoracic tuberculosis. Pediatr Radiol. 2023; 53: 1773-81.
54
Ankrah AO, van der Werf TS, de Vries EF, Dierckx RA, Sathekge MM, Glaudemans AW. PET/CT imaging of Mycobacterium tuberculosis infection. Clin Transl Imaging. 2016; 4: 131-44.
55
McClean M, Panciu TC, Lange C, Duarte R, Theis F. Artificial intelligence in tuberculosis: a new ally in disease control. Breathe (Sheff). 2024; 20: 240056.
