Since the diagnosis of extrapulmonary tuberculosis (EPT) is largely depended on the physician's suspicion in respect of the disease, we believed that it would be worthwhile to scrutinize the clinical characteristics of EPT. Thus, here we present retrospectively evaluated clinical manifestations of patients who were diagnosed as EPT cases in a tertiary referral care hospital. Medical records of 312 patients, diagnosed as having EPT at Yongdong Severance hospital from January 1997 to December 1999, were reviewed retrospectively. In total 312 patients, 149 (47.8%) males and 163 (52.2%) females aged from 13 years to 87 years, were included into this study. The most common site of the involvement was pleura (35.6%). The patients complained of localized symptoms (72.4%) more frequently than systemic symptoms (52.2%). The most common symptom was pain at the infected site (48.1%). Leukocytosis, anemia, and elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were found in 12.8%, 50.3%, 79.3% and 63.1% of the patients, respectively. Twenty-four percent of the patients had underlying medical illnesses such as, diabetes mellitus or liver cirrhosis, or were over 60 years old. In 67.3% of patients, tuberculosis was suspected at the initial visit. However, tuberculosis was microbiologically proven in only 23.7% of the patients. The time interval from the symptom onset to the diagnosis varied, with the mean duration of the period 96 days. Pulmonary parenchymal abnormal lesions were found in 133 patients (42.6%) on chest radiographs. EPT has a wide spectrum of clinical manifestations, so it is difficult to diagnose it. Based on our studies, only 11.2% of the patients were confirmed as EPT. So it is important that the physician who first examines the patient should have a high degree of suspicion based on the chest radiography, localized or systemic symptoms and several laboratory parameters reviewed in this study.
Adolescent ; Adult ; Aged ; Biopsy ; Female ; Human ; Incidence ; Male ; Middle Aged ; Prevalence ; Retrospective Studies ; Tuberculosis/*epidemiology/*pathology/radiography ; Tuberculosis, Lymph Node/epidemiology/pathology/radiography ; Tuberculosis, Osteoarticular/epidemiology/pathology/radiography ; Tuberculosis, Pleural/epidemiology/pathology/radiography ; Tuberculosis, Pulmonary/epidemiology/pathology/radiography

BACKGROUND: Solitary pulmonary nodule (SPN) may show different pre- sentation in tuberculosis (TB)-endemic countries. The aim of this study was to identify clinical and radiological predictors favoring benign or malignant SPN in TB-endemic region. METHODS: Two hundred one SPNs in 201 consecutive Korean patients were included (< 3 cm in diameter, all confirmed by pathology or bacteriology, 93 benign and 108 malignant diseases). For clinical parameters, age, sex, smoking status and amount, and past history of pulmonary tuberculosis and diabetes mellitus were investigated retrospectively. For radiological parameters, size, location, margin characteristics, presence of calcification, pleural tag, surrounding satellite nodule, cavitation, internal low attenuation, open bronchus sign, surrounding ground-glass opacity, enhancement pattern of the SPNs and mediastinal lymph node (LN) enlargement were analyzed on chest CT scans. RESULTS: Patients with a older age (60.7+/-9.6 vs 56.2+/-13.1, p=0.008) and more than 40-pack years smoking (27.8% vs 14.0%, p=0.017) were more frequently related with malignant than benign SPN. On chest CT scans, spiculated margin, contrast enhancement more than 20 Hounsfield unit and presence of pleural tag and mediastinal LN enlargement were more frequently observed in malignant than benign SPNs. In contrast to previous studies, satellite lesions (21.5% vs 1.9%, p < 0.001) and cavitation (20.4% vs 5.6%, p=0.001) were more frequently seen in benign than malignant SPN. Positive predictive values of benignity were 90.9% and 76.0%, respectively, when satellite lesions and cavitation were found in cases of SPN. CONCLUSION: Satellite lesions and cavitation on chest CT scan could be useful predictors for benign SPN in TB-endemic areas.
Adult ; Age Factors ; Carcinoma/pathology/radiography ; Coin Lesion, Pulmonary/*pathology/*radiography ; Female ; Human ; Korea ; Lung Neoplasms/pathology/radiography ; Male ; Middle Age ; Multivariate Analysis ; Predictive Value of Tests ; Retrospective Studies ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary/*pathology/*radiography

Pulmonary aspergillosis is classified as a saprophytic, allergic, and invasive disease. Chronic necrotizing pulmonary aspergillosis is categorized as an invasive pulmonary aspergillosis. Most invasive pulmonary aspergillosis have acute and toxic clinical features but chronic necrotizing pulmonary aspergillosis is characterized by a sub-acute infection, most commonly seen in patients with altered local defense system from preexisting pulmonary disease of in mild immunocompromised patients. Pulmonary artery aneurysm due to this infection is termed as a mycotic aneurysm, etiology of which are tuberculosis, syphilis, bacteria and fungus. We report a case chronic necrotizing pulmonary aspergillosis complicating pulmonary aneurysm is a 62 year-old man who was presented with cough, sputum, and fever. Chest radiographs showed a rapid, progressive cavitary lesion and pulmonary artery aneurysm. Angioinvastion of aspergillus was revealed by pathology after operative removal of left upper lobe containing the pulmonary artery aneurysm. He was treated with itraconazole.
Aneurysm* ; Aneurysm, Infected ; Aspergillus ; Bacteria ; Cough ; Fever ; Fungi ; Humans ; Immunocompromised Host ; Invasive Pulmonary Aspergillosis* ; Itraconazole ; Lung Diseases ; Pathology ; Pulmonary Artery* ; Pulmonary Aspergillosis ; Radiography, Thoracic ; Sputum ; Syphilis ; Tuberculosis

We report a case of central venous stenosis due to a structural deformity caused by a tuberculosis-destroyed lung in a 65-year-old woman. The patient presented with left facial edema. She had a history of pulmonary tuberculosis, and the chest X-ray revealed a collapsed left lung. Angiography showed leftward deviation of the innominate vein leading to kinking and stenosis of the internal jugular vein. Stent insertion improved her facial edema.
Aged ; Brachiocephalic Veins/*pathology/radiography ; *Central Venous Pressure ; Constriction, Pathologic/*etiology/pathology/therapy ; Edema/therapy ; Female ; Humans ; Jugular Veins/pathology/radiography ; Stents ; Tuberculosis, Pulmonary/*complications/pathology/radiography ; Vascular Diseases/*etiology/pathology/therapy

Pulmonary tuberculosis is still serious, one of the great public health problems in Korea. Recently, the increase in the aged population, human immunodeficiency virus coinfection, and drug-resistant tuberculosis have reinforced the need for improved rapid diagnostics and better treatment strategies. The basic principles of care for persons with, or suspected of having, pulmonary tuberculosis are the same worldwide. The standard guidelines and recent advances in diagnosis and treatment are summarized in this article. Prompt, accurate diagnosis of pulmonary tuberculosis should be established using chest radiography, sputum microscopy, and culture in liquid and solid medium. The further evaluation of chest imaging, histopathological examination of biopsy samples, nucleic acid amplification tests, immunological evaluation, and new molecular diagnostic tests supplement earlier, improved diagnosis, especially in patients with smear-negative pulmonary tuberculosis. Standardized treatment regimens of proven efficacy should be used with appropriate patient education and treatment support. The response to treatment and the presence of side effects of antituberculosis drugs should be monitored regularly. In addition, essential public health responsibilities and public-private collaboration must be carried out for effective patient care and pulmonary tuberculosis control.
Biopsy ; Coinfection ; Cooperative Behavior ; Diagnosis* ; HIV ; Humans ; Korea ; Microscopy ; Nucleic Acid Amplification Techniques ; Pathology, Molecular ; Patient Care ; Patient Education as Topic ; Public Health ; Radiography ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Multidrug-Resistant ; Tuberculosis, Pulmonary*

OBJECTIVETo explore the clinical value of CT-guided percutaneous needle biopsy (PCNB) for diagnosis of atypical pulmonary tuberculosis.

METHODSThe data from 15 patients undergoing diagnostic PCNB for pulmonary tuberculosis were retrospectively analyzed. Prior to PCNB, definitive diagnosis failed to be obtained from other examinations including sputum smear in 10 cases, fiberoptic bronchoscopy in 12, chest X-ray in 13, CT scan in 15, and position emission tomography (PET) with CT examination in 1 case.

RESULTSSputum smears and fiberoptic bronchoscopy both failed to produce positive results and pulmonary and/or mediastinal lesions were shown by chest X-ray, CT, and PET-CT. Pulmonary tuberculosis were diagnosed in the 15 cases by histopathological examination following PCNB, and pneumothorax in relation to PCNB occurred in 3 cases and hemoptysis in 1 case.

CONCLUSIONPCNB provides a safe and accurate means for diagnosis of pulmonary tuberculosis when imaging and other diagnostic modalities fail to result.

Adolescent ; Adult ; Biopsy, Needle ; methods ; Female ; Humans ; Male ; Middle Aged ; Radiography, Interventional ; Reproducibility of Results ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary ; diagnosis ; diagnostic imaging ; pathology

Pulmonary tuberculosis (PTB) is a common infectious disease worldwide. However, mediastinal tuberculous lymphadenitis complicated by oesophageal involvement and oesophago-respiratory fistula is now uncommon due to improved anti-tuberculous regimes and better general awareness. The overall incidence of acquired oesophago-respiratory fistula due to infection is low, and therefore, the lesion is not often a frontrunner in differential diagnosis. Still, tuberculous oesophago-respiratory fistulae can potentially occur in patients with retroviral disease, as they tend to have atypical and more virulent manifestations. In this study, we report the case of multiple oesophago-respiratory fistulae in a patient with PTB and retroviral disease, and highlight the computed tomography features of these lesions as an atypical presentation of PTB in retroviral disease. Clinicians should suspect oesophago-respiratory fistulae if patients present with Ono’s sign, and remain particularly vigilant for patients with underlying PTB and retroviral disease, as early diagnosis and treatment could help to reduce mortality.
Adult ; Diagnosis, Differential ; Esophagus ; physiopathology ; Fistula ; diagnosis ; Humans ; Lung ; pathology ; Male ; Radiography, Thoracic ; Retroviridae ; metabolism ; Tomography, X-Ray Computed ; Trachea ; physiopathology ; Treatment Outcome ; Tuberculosis, Lymph Node ; Tuberculosis, Pulmonary ; complications ; diagnosis

PURPOSE: To discuss computed tomography (CT) evaluation of the etiology of vocal cord paralysis (VCP) due to thoracic diseases. MATERIALS AND METHODS: From records from the past 10 years at our hospital, we retrospectively reviewed 115 cases of VCP that were evaluated with CT. Of these 115 cases, 36 patients (23 M, 13 F) had VCP due to a condition within the thoracic cavity. From these cases, we collected the following information: sex, age distribution, side of paralysis, symptom onset date, date of diagnosis, imaging, and primary disease. The etiology of VCP was determined using both historical information and diagnostic imaging. Imaging procedures included chest radiograph, CT of neck or chest, and esophagography or esophagoscopy. RESULTS: Thirty-three of the 36 patients with thoracic disease had unilateral VCP (21 left, 12 right). Of the primary thoracic diseases, malignancy was the most common (19, 52.8%), with 18 of the 19 malignancies presenting with unilateral VCP. The detected malignant tumors in the chest consisted of thirteen lung cancers, three esophageal cancers, two metastatic tumors, and one mediastinal tumor. We also found other underlying etiologies of VCP, including one aortic arch aneurysm, five iatrogenic, six tuberculosis, one neurofibromatosis, three benign nodes, and one lung collapse. A chest radiograph failed to detect eight of the 19 primary malignancies detected on the CT. Nine patients with lung cancer developed VCP between follow-ups and four of them were diagnosed with a progression of malignancy upon CT evaluation of VCP. CONCLUSION: CT is helpful for the early detection of primary malignancy or progression of malignancy between follow-ups. Moreover, it can reveal various non-malignant causes of VCP.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lung Neoplasms/complications/pathology ; Male ; Middle Aged ; Neoplasm Invasiveness ; Recurrent Laryngeal Nerve/pathology ; Retrospective Studies ; Thoracic Diseases/*complications ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary/complications ; Vocal Cord Paralysis/*etiology/*radiography

Adrenal Cortex Hormones ; therapeutic use ; Antiviral Agents ; therapeutic use ; Diagnosis, Differential ; Granulomatosis with Polyangiitis ; diagnosis ; Humans ; Lung Neoplasms ; diagnostic imaging ; drug therapy ; pathology ; Lymphomatoid Granulomatosis ; diagnostic imaging ; drug therapy ; pathology ; Prognosis ; Radiography ; Sarcoidosis ; diagnosis ; Tuberculosis, Pulmonary ; diagnosis

BACKGROUND: The radiographic characteristics of tuberculous pneumonia in adults are similar to primary tuberculosis that occurs in childhood, and upper lobe cavitary tuberculosis is the hallmark of postprimary tuberculosis. The purpose of this study was to investigate the factors associated with tuberculous pneumonia by making comparison with cavitary tuberculosis. METHODS: The medical records and radiographic findings of patients with cavitary tuberculosis and tuberculous pneumonia, and who were diagnosed between March 2003 and February 2006, were analyzed retrospectively. RESULTS: Forty patients had cavitary tuberculosis and sixteen patients had tuberculous pneumonia. Fever was more frequent for tuberculous pneumonia, whereas hemoptysis was more frequent for cavitary tuberculosis. The duration of symptoms before visiting the hospital was shorter, but the diagnosis after admission was more delayed for tuberculous pneumonia patients than for cavitary tuberculosis patients. The prevalence of underlying comorbidities such cancer, diabetes, alcoholism and long-term steroid use was not different between the two groups. The patients with tuberculous pneumonia were older and they had lower levels of serum albumin and hemoglobin than those with cavitary tuberculosis. The patients with tuberculous pneumonia showed a tendency to have more frequent endobronchial lesion. Tuberculous pneumonia occurred in any lobe, whereas the majority of cavitary tuberculosis patients had upper lung lesion, but the prevalence of lymphadenopathy, pleural effusion and previous tuberculosis scar was not different between the two groups. CONCLUSIONS: Older age, a lower level of serum albumin and hemoglobin and a random distribution of lesion were associated with tuberculosis pneumonia as compared with cavitary tuberculosis. These findings suggest that the pathogenesis of tuberculous pneumonia might be different from that of cavitary tuberculosis.
Tuberculosis, Pulmonary/blood/*diagnosis/microbiology ; Tomography, X-Ray Computed ; Sputum/microbiology ; Severity of Illness Index ; Serum Albumin/metabolism ; Retrospective Studies ; Radiography, Thoracic ; Pneumonia, Bacterial/blood/*diagnosis/microbiology ; Mycobacterium tuberculosis/isolation & purification ; Middle Aged ; Male ; Lung/microbiology/pathology/radiography ; Humans ; Hemoglobins/metabolism ; Female ; Diagnosis, Differential ; Bronchoscopy ; Biopsy ; Adult