Imagerie de la tuberculose pulmonaire

Abstract

Pulmonary tuberculosis is a relatively rare disease in France, outside risk populations (migrants; deprived socioeconomic background; chronic disease). It remains a major cause of morbidity and mortality worldwide, in particular in patients infected with human immunodeficiency virus (HIV) and because of the emergence of resistance to tuberculosis treatment in some countries. The disease has become difficult to control in certain populations due to the high prevalence of latent tuberculosis and reactivation. Radiological manifestations of pulmonary tuberculosis may vary depending on factors related to the host, especially tuberculosis history, age and immune status. Chest X-ray imaging remains the first line exploration, and is still used, despite its shortcomings, for screening patients at risk. Computed tomography can guide the diagnosis in difficult cases, highlighting signs of disease activity (cavitation, bronchial dissemination nodules and centrilobular micronodules, necrotic lymphadenopathy), accelerating therapeutic management. It allows the diagnosis of complications (fistula formation, miliary pulmonary destruction), especially hemoptysis. Computed tomography can be useful during or at the end of treatment in case of adverse developments and to review fibrotic sequelae. Specific clinical situations (immunosuppression, HIV infection, elderly patients) are discussed. In a second part of this review, chest involvement related to non-tuberculous mycobacteria (MBNT) will be considered. These are rare infections, linked to the inhalation of non-tuberculosis organisms (mainly Mycobacterium avium-intracellulare and Mycobacterium kansasii) without human transmission. Typically, it is an indolent fibrocavitary or nodular-bronchiectasic granulomatous lung infection.