RADIOGRAPHIC SPECTRUM OF ADULT PULMONARY TUBERCULOSIS IN A DEVELOPED COUNTRY

Setting. Bispebjerg Hospital, Department of Pulmonary Medicine P. The referral centre of adult tuberculosis in the municipality of Copenhage n, Denmark. Objective. To evaluate the radiographic spectrum of pulmon ary tuberculosis (TB) in adults in a low-prevalence country and to cor relate radiographic appearances with bacteriological results, clinical and demographic data. Design. Retrospective review of medical files o n 548 cases with pulmonary TB according to the criteria of WHO. Result s. Usual radiographic pattern of reactivating TB, with upper lobe invo lvement, was found in 92% (n = 504). eight percent (n = 44) showed unu sual X-ray patterns for adults, such as isolated lower lobe infiltrati ons (n=19), hilar adenopathy (n=10), military TB (n=7), tuberculoma (n =2), pleural effusion (n=1) and normal chest X-ray (n=3). Eighty-nine percent of cases with cavitary lesions were positive by microscopy. Co nclusion. The risk of missing a diagnosis of pulmonary TB may be high if patients present with an X-ray unusual for TB, but this is fortunat ely seen only in 8% of cases of pulmonary tuberculosis. Unusual X-ray is more commonly found in patients with concomitant disease, such as d iabetes and cancer. If chest X-ray shows cavities, but the smear is ne gative for Mycobacterium, TB is unlikely and further diagnostic proced ures should be performed without waiting for culture results.