대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Miliary Tuberculosis with ARDS, mediastinal and interstitial emphysema, and cystic changes

Radiologic Findings

Chest radiographs show diffuse ground-glass opacities with fine nodules in both entire lungs (Fig 1).
At initial HRCT scan (Fig. 2,3), diffuse ground glass attenuation with miliary nodules are seen in both lungs, and present ARDS caused by miliary tuberculosis.
Also note subcutaneous and mediastinal emphysema. Interstitial emphysema in the lungs and air densities in spinal canal are noted in HRCT scan (Fig. 2,3).
At follow-up HRCT scan after 1 month, numerous cystic lesions are newly developed in both lungs, particularly upper lung zones.
Previously noted ground-glass attenuation are cleared and widespread miliary nodules are more improved (Fig. 4,5). These cystic lesions develop recurrent pneumothorax in follow-up studies.

Brief Review

Pulmonary tuberculosis occasionally appears with acute respiratory failure or adult respiratory distress syndrome (ARDS), and miliary tuberculosis is a rare cause of ARDS.
Pulmonary tuberculosis presenting with acute respiratory failure leads to high mortality rate.
When pulmonary tuberculosis is associated with acute respiratory failure, chest radiographs show diffuse bilateral opacity, and HRCT scans show a miliary pattern of micronodules and tree-in-bud appearance with background areas of ground-glass attenuation.
Long-term follow-up radiographs show complete disappearance of the micronodular lesions.
But multiple reversible air-filled cystic lesions are rarely developed during follow-up period in patients with pulmonary tuberculosis presenting with diffuse pulmonary opacity and clinically acute respiratory failure.

References

1. Choi D, Lee KS, Suh GY et al. Pulmonary tuberculosis presenting as acute respiratory failure: Radiologic findings. JCAT 1999;23:107-113
2. Ko KS, Lee KS, Kim Y, Kim SJ, Kwon O, Kim JS. Reversible cystic disease associated with pulmonary tuberculosis: Radiologic findings. Radiology 1997;204:165-169

Keywords

Lung, Infection, Bacterial infection, tuberculosis,