Practice Essentials

Primary tuberculosis has generally been defined as onset of clinical disease within 12 months of initial infection with Mycobacterium tuberculosis.^[1]Tuberculosis may involve multiple organs, such as the lung, liver, spleen, kidney, brain, and bone. In endemic regions, the normal host immune response may be sufficient to contain the infection and prevent clinical presentation. Uncontrolled or uncontained infection may result in high morbidity and mortality. A third of the world's population is said to have contracted M tuberculosis, with estimates of 10 million new infections globally each year. The major pathology is necrotizing granulomatous inflammation, with the lungs being the primary organs of involvement in up to 87% of cases.^{[2, 3, 4]}

If patients with primary tuberculosis undergo imaging, a conventional chest radiograph may be sufficient for diagnosis in the appropriate clinical setting.^{[1, 5]}(A case of primary pulmonary tuberculosis is depicted in the image below.) In patients with progressive primary or postprimary tuberculosis, computed tomography scanning is often performed, in addition to chest radiography.^[5]Magnetic resonance imaging may be used to evaluate complications of thoracic disease, such as the extent of thoracic wall involvement with empyema, but is of limited value in the evaluation of patients with pulmonary tuberculosis.^{[6, 7, 8, 9, 10]}

Early in the disease, chest radiographs are usually normal.

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Media Gallery

Young male patient with fever and cough has a focal opacity in the left lower lobe that looks like a pneumonia. This is a case of primary tuberculosis in an adult.
Posteroanterior chest radiograph in a young patient shows a right upper lobe and right lower lobe consolidation and a small pleural effusion on the right side.
CT scan in a young patient, obtained with the pulmonary window setting, demonstrates consolidation in the right upper lobe, ground-glass opacities in the right lower lobe, and a pleural effusion on the right side. This patient has extensive tuberculous pneumonia and is immunocompromised.
A middle-aged man presents with a cough and fever lasting several weeks. Posteroanterior chest radiograph shows a prominent paratracheal area on the right, lymphadenopathy, a cavitary opacity in the right upper lobe, and a focal consolidation in the middle lung zone on the right. The patient was ultimately found to have primary progressive tuberculosis.
A middle-aged man presents with a cough and fever lasting several weeks. CT scan obtained with the pulmonary window setting in the right upper lobe shows an irregular, thick-walled cavity with some increased markings around it. A nearby nodule is also shown.
CT scan obtained with pulmonary window setting in the right middle lobe (same patient as in the previous image) shows a focal area of consolidation with what may be tiny nodules. This patient has primary progressive tuberculosis with radiographic manifestations of mediastinal adenopathy, cavitary process, and endobronchial spread that occurs over a short period. He had a history of alcohol abuse.
Pulmonary Tuberculosis with Air fluid Level

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