CT can distinguish pneumonia from tuberculosis

Some patients are unable to judge what disease they have when they experience symptoms of chest tightness and shortness of breath, and may even confuse pneumonia and tuberculosis. In fact, the severity and treatment methods of these two diseases are completely different. If tuberculosis occurs, the symptoms will be more serious and require a combination of Chinese and Western medicine and daily care and other multi-faceted treatment methods.

(I) Chest X-ray examination is the most traditional, convenient and rapid examination for diagnosing pulmonary tuberculosis. It is of great value in understanding the location, extent and nature of the lesions and the evolution of the disease. Different types of pulmonary tuberculosis have their own X-ray imaging characteristics.

⒈ Primary syndrome: The typical lesion manifests as a dumbbell-shaped bipolar phenomenon, with the primary lesion in the lung at one end and the enlarged lymph nodes in the ipsilateral hilum and mediastinum at the other end, and inflamed lymphatic vessels in the middle. Primary tuberculosis lesions in the lungs are generally single, and initially present as soft, uniform, and clearly demarcated infiltration changes. If the lesions continue to expand, they may involve the entire lung lobe. Lymphangitis is one or several cord-like shadows extending from the lesion to the hilum of the lung. The ipsilateral hilar and mediastinal lymph nodes are enlarged with smooth or lobed margins. When enlarged lymph nodes compress the bronchi, causing them to narrow and block, a triangular shadow appears near the hilum of the lung with the base toward the hilum and the tip toward the edge of the lung. This type of segmental or lobar atelectasis is more common in the right middle lobe and sometimes occurs in the anterior segment of the right upper lobe.

⒉ Hematogenous disseminated pulmonary tuberculosis: manifested by miliary shadows of similar density and size that are widely and evenly distributed in both lungs, the so-called "three uniform" X-ray sign. The miliary shadows of subacute and chronic hematogenously disseminated pulmonary tuberculosis are unevenly distributed, of varying ages, densities, and sizes.

⒊ Secondary pulmonary tuberculosis: The lesions mostly occur in the posterior segment of the apex of the upper lobe and the dorsal segment of the lower lobe. The lesions may be localized or may invade multiple lung segments. X-ray images may show polymorphic manifestations (i.e., exudation, proliferation, fibrous and caseous lesions are present at the same time) and may also be accompanied by calcification. It may be accompanied by bronchial dissemination, pleural effusion, pleural thickening and adhesion. It is easy to merge with cavities. Typical tuberculous cavities appear as thin-walled cavity shadows with smooth inner walls, sometimes with fluid levels, and visible draining bronchus. Atypical tuberculous cavities can be divided into wallless, tension, caseous thick-walled or oval, and there may be no or varying amounts of surrounding inflammation and fibrosis. Caseous pneumonia lesions are often limited to one lung segment or one lobe. The initial lesions appear as ground-glass, diffuse inflammatory shadows, which are denser than the simple exudative shadows of general pneumonia. High-density caseous lesions can be vaguely seen in the large inflammatory shadows. After the lesions dissolve, transparent areas of varying shapes and sizes may appear in the dense inflammatory shadows. The lysis of lobular caseous pneumonia is not obvious. When the lesion is spherical (tuberculoma), its diameter is usually less than 3 cm. There may be satellite lesions around it and drainage bronchus signs at the inner end. The lesion is absorbed slowly (little change within one month). In the late stage of pulmonary tuberculosis, honeycomb lung and damaged lung can be seen, which are often manifested as extensive fibrosis in both lungs or one side of the lung, thick-walled fibrous cavities and lesions spread along the bronchi. Various images may occur, such as chest deformity, mediastinal shift, diaphragm descent, hanging heart, willow-shaped lung patterns and pleural thickening caused by a large amount of fibrous tissue and emphysema.