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High-resolution CT findings of pulmonaryMycobacterium tuberculosisinfection in renal transplant recipients

医学 胸腔积液 粟粒性肺结核 病理 移植 放射科 肺结核 外科 内科学
作者
Marisa Pereira,Fernando Ferreira Gazzoni,Edson Marchiori,Klaus Irion,José da Silva Moreira,Irai Luis Giacomelli,Alessandro C. Pasqualotto,Bruno Hochhegger
出处
期刊:British Journal of Radiology [Wiley]
卷期号:89 (1058): 20150686-20150686 被引量:19
标识
DOI:10.1259/bjr.20150686
摘要

Objective: Renal transplantation recipients are at increased risk of Mycobacterium tuberculosis infection because of immunosuppression. The aim of this study was to assess high-resolution CT (HRCT) findings in renal transplantation recipients diagnosed with pulmonary tuberculosis (TB). Methods: We reviewed HRCT findings from patients diagnosed with pulmonary TB, established by M. tuberculosis detection in bronchoalveolar lavage, sputum or biopsy sample. Two observers independently reviewed HRCT images and reached consensus decisions on the presence and distribution of: (i) miliary nodules, (ii) cavitation and centrilobular tree-in-bud nodules, (iii) ground-glass attenuation and consolidation, (iv) mediastinal lymph node enlargement and (v) pleural effusion. Results: The sample comprised 40 patients [26 males, 14 females; median age, 45 years (range, 12–69 years)]. The main HRCT pattern was miliary nodules (40%), followed by cavitation and centrilobular tree-in-bud nodules (22.5%), ground-glass attenuation and consolidation (15%), mediastinal lymph node enlargement (12.5%) and pleural effusion (10%). The distribution of findings in patients with miliary nodules was random. In patients with cavitation and centrilobular tree-in-bud nodules, 66.6% of abnormalities were found in the upper lobes. Pleural effusion was unilateral in 75% of cases. The overall mortality rate was 27.5%. This rate was 50% in patients with miliary nodules, and 72.6% of all deaths occurred in this group. Thus, mortality was increased significantly in patients with miliary nodules (p < 0.05). Conclusion: The main HRCT finding in renal transplantation recipients with pulmonary TB was miliary nodules, followed by cavitation and centrilobular tree-in-bud nodules. Miliary nodules were associated with a worse prognosis in these patients. Advances in knowledge: We report the first series on HRCT findings of microbiologically confirmed pulmonary TB exclusively in renal transplantation recipients. The main HRCT finding was miliary nodules, and mortality was increased significantly in these patients.
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