ATYPICAL RADIOLOGICAL MANIFESTATIONS OF ACTIVE PULMONARY TUBERCULOSIS IN SERIES OF PATIENTS FROM NORTH MACEDONIA ON COMPUTED TOMOGRAPHY

Abstract

Immunocompromised and patients with chronic diseases worldwide, as well as from North Macedonia, have a greater probability of acquiring tuberculosis (TB) in their lifetime, which is caused by the mycobacterial species and still represents one of the major burdens of the public health systems, as well as one of the most frequent causes of death. The disease itself can manifest in two forms, active and dormant. The active form of the disease manifests shortly after acquiring the infection, whilst the dormant one can occur after years of latency as a postprimary form. Negative microbiology results in tuberculous patients can delay and complicate the accurate diagnosis, so the diverse diagnostic imaging modules, especially the computed tomography (CT), have a supreme role in diagnosing, and following patients with pulmonary tuberculosis (PTB) after treatment. Purpose: Our aim was to illustrate and analyze some atypical appearances of active pulmonary tuberculosis (PTB) in series of 30 patients from North Macedonia on computed tomography (CT). Methodology: 30 consecutive chest CT scans of patients with microbiologically proven tuberculosis from North Macedonia were thoroughly analyzed. All patients underwent a non- contrast and then a contrast enhanced chest CT according to appropriate diagnostic protocol on a 64-slice Somatom Definition AS + computed tomograph (Siemens Healthineers, USA). We reviewed 30 CT scans and all the available information from the medical history of the patients, including their microbiology results. Results: Some of the uncommon signs of PTB we observed on the CTs included: (1) various clusters of micronodules; (2) cystic patterns in PTB patients; (3) PTB with diffusely scattered non miliary nodules, (4) PTB in the setting of COVID 19 pneumonia, (5) organizing pneumonia. Conclusion: Aside from the obvious decrease of the PTB incidence globally, there is an evident rise of atypical manifestations, clinically and on imaging. Mastering the knowledge of atypical CT imaging signs in active PTP will help in reaching diagnosis, following treatment response or residual activity of PTP in clinical practice. Diagnostic imaging also aids the detection of complications or sequels from the disease.