Radiographic spectrum of adult pulmonary tuberculosis in a developed country

Respir Med. 1998 Mar;92(3):493-7. doi: 10.1016/s0954-6111(98)90297-9.


Setting: Bispebjerg Hospital, Department of Pulmonary Medicine P. The referral centre of adult tuberculosis in the municipality of Copenhagen, Denmark.

Objective: To evaluate the radiographic spectrum of pulmonary tuberculosis (TB) in adults in a low-prevalence country and to correlate radiographic appearances with bacteriological results, clinical and demographic data.

Design: Retrospective review of medical files on 548 cases with pulmonary TB according to the criteria of WHO.

Results: Usual radiographic pattern of reactivating TB, with upper lobe involvement, was found in 92% (n = 504), eight percent (n = 44) showed unusual X-ray patterns for adults, such as isolated lower lobe infiltrations (n = 19), hilar adenopathy (n = 10), miliary TB (n = 7), tuberculoma (n = 2), pleural effusion (n = 1) and normal chest X-ray (n = 3). Eight-nine percent of cases with cavitary lesions were positive by microscopy.

Conclusion: 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 fortunately seen only in 8% of cases of pulmonary tuberculosis. Unusual X-ray is more commonly found in patients with concomitant disease, such as diabetes and cancer. If chest X-ray shows cavities, but the smear is negative for Mycobacterium, TB is unlikely and further diagnostic procedures should be performed without waiting for culture results.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Denmark
  • Developed Countries*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mycobacterium tuberculosis / isolation & purification
  • Radiography
  • Retrospective Studies
  • Sputum / microbiology
  • Tuberculosis, Pulmonary / diagnostic imaging*