1. PULMONARY TUBERCULOSIS

2. • Causative agent: M. tuberculosis (<5% atypical)
• Transmitted via air-borne droplet nuclei (1-5 um)
• Main indicator for potential for transmission: presence of acid-fast
bacilli in the sputum smear
• Increased probability of transmission:
• Positive sputum culture for M. tuberculosis
• Cavitation on CXR
• TB laryngitis
• High volume and watery respiratory secretions

4. Factors that predispose to infection
 old age
 poor nutrition
alcoholism
silicosis
diabetes
pregnancy
 malignant disease
immunosuppression, especially by HIV infection

5. TB infection begins – mycobacteria reach
pulmonary alveoli
• Invade and replicate within alveolar
macrophages
• Interact with T lymphocyte to form
granuloma
• Within granuloma, cytokines from T
lymphocytes activate macrophages to
destroy the inhaled mycobacteria.
• However, bacteria are not always eliminated
from granuloma, can become dormant,
resulting in the latent infection
• Another feature of TB granuloma –
development of central necrosis.

6. • Definitive diagnosis – culture of M. tuberculosis
• Complete evaluation:
• Medical history
• Chest radiograph
• Physical examination
• Microbiologic smears and cultures
• May include tuberculin skin test and serologic test
• For latent infection: tuberculin skin test (delayed hypersensitivity response
to PPD of M. tuberculosis)
• Recently, whole blood interferon-y assay introduced for diagnosis of latent TB
(higher accuracy than TST)

7. • Diagnosis primarily relies upon microbiological identification
• When culture not possible, radiology plays a vital role in diagnosis,
treatment
• In absence of microbiological confirmation of PTB, a decision to treat –
based upon clinical and radiologic suspicion
• To interpret radiological findings – must be aware of wide spectrum of
radiographic presentations of PTB
• Features distinguishing active from quiescent disease
• Radiologic changes with response to Rx or suggesting resistance

8. Primary Pulmonary Tuberculosis
• Primary tuberculosis is usually a self-limited infection seen in children
in endemic regions.
• As many as 60% of children and 5% of adults with primary
tuberculosis are asymptomatic.
• Patients with primary pulmonary tuberculosis may be minimally
symptomatic, with minimal constitutional symptoms.
• Children may present with fever, malaise, weight loss, cough, and
occasional hemoptysis

9. Primary Pulmonary Tuberculosis
• Organisms settle and multiply in an alveolus anywhere in the lungs, but most
commonly in a subpleural site in the well ventilated lower lobes.
• Initially an area of peripheral consolidation (the Ghon focus), then spread along
the draining lymphatics may lead to enlargement of regional lymph nodes. This
combination is referred to as a primary complex.
• Subpleural infection may cause a serous effusion.
• Activation of the immune system usually leads to resolution, healing and fibrosis
at this stage.
• Usually a fibrous capsule walls off the lesion and dystrophic calcification may occur.
• If the response to infection is weak the disease may progress and there is little
difference between lesions of primary and post-primary evolution.
• may manifest as further consolidation, possibly with cavitation, and bronchogenic spread of
infection.

10. Post Primary Tuberculosis
• Follows the primary infection after a latent interval, however short or long, and is
due to either reactivation or reinfection.
• Now generally accepted that almost all post-primary tuberculosis is due to reinfection.
• As distinct from primary infection site, in which healing is the rule, reactivation
TB tends to progress.
• Lesions usually start in the apical and posterior segments of the upper lobes or
in the superior segment of the lower lobes as small areas of exudative
inflammation. These extend, coalesce, caseate and cavitate.
• Typically there is a large cavity with several smaller satellite cavities, often bilateral but more
advanced on one side.
• Cavity walls are lined by tuberculous granulation tissue and traversed by fibrotic remnants of
bronchi and vessels.
• A vessel which has not been totally obliterated may dilate-a Rasmussen aneurysm.

11. Post Primary Tuberculosis
• Dispersal of infection from the cavities to other parts of the lungs
takes place as in the primary form, and results in numerous small
areas of caseous pneumonia, often in the lower lobes. Massive
dispersal may lead to caseation of whole lobe.
• Adhesions usually limit pleural spread but sometimes the lung
becomes encased in a thick coating of caseous material, fibrosis and
hyaline connective tissue.
• Small cavities that heal leave radiating fibrotic strands puckering the
lung.
• Large cavities become lined by columnar or squamous epithelium and
are prone to secondary infection or fungal colonization.

12. Radiographic Screening
• Purpose: to identify the persons with active TB
• Although combined with tuberculin skin testing, it is the initial screening
method when:
• Tuberculin skin test may be unreliable
• Reading of skin test may be impractical
• Risks of transmission of an undiagnosed case are high as occurs in institutional
settings (jails, hospital, long term care facilities)
• Because of considerable mortality and morbidity associated with congenital
and perinatal transmission of TB, it is recommended pregnant women in
high risk groups or from areas with a high prevalence of both HIV and TB
infection undergo screening.

13. • Joint statement from American Thoracic Society and CDC – persons infected
with M. tuberculosis (+tuberculin) should be classified on the basis of
clinical, bacteriologic, and radiographic evaluation into one of the 3
categories:
• TB infection, no disease
• TB infection, clinically active; and
• TB infection, clinically inactive
• Normal CXR – high negative predictive value for active TB

14. • Single screening CXR – detection of any abnormality (parenchymal, nodal
or pleural) with or without associated calcification should result in
interpretation of indeterminate disease activity.
• Radiographic differentiation between active and inactive disease – reliably
made only on the basis of temporal evolution.
• Lack of radiographic change over a 4- 6 month interval – generally inactive disease
• However, even long-term stability of radiographic findings may occasionally be
associated with culture- positive disease. Thus, such findings should be described as
radiographically stable rather than inactive.

15. Terminologies
• Primary (Ghon) focus – initial site of parenchymal
involvement at the time of 1st infection. It
represents a calcified tuberculous caseating
granuloma.
• Primary (Ghon) Complex - Primary focus +
involvement of regional lymph nodes
• Ranke complex – combination of a Ghon focus and
calcified lymph nodes
• Simon foci – apical nodules that are often calcified
(result from hematogeneous seeding at the time of
initial infection)
• Assmanns focus – infraclavicular infiltrate of TB
• Purl’s lesion - Lesion at the apex of lung in chronic
TB - commonest site of isolated lesion in chronic TB

16. Radiological Findings In Primary Infection
• Common findings include
• Segmental or lobar airspace consolidation
• Ipsilateral hilar and mediastinal lymphadenopathy
• Pleural effusion
• Atelectasis may occur often as a consequence of tuberculous airway
involvement/ obstruction by enlarged LN

17. • Parenchymal opacities
• May occur in any segment or lobe or in
multiple segments or lobes, predilection for the
lower lobes, for the middle lobe and lingula,
and for the anterior segments of the upper
lobes.
• Subpleural lesion- Ghon focus
• Consolidation tends to be homogeneous, with
ill-defined margins. If the consolidation abuts a
fissure, a well-defined margin may be
identified.
• Cavitation within parenchymal opacity is
distinctly uncommon in primary infection Bilateral upper lobe disease ,Soft
puffy infiltrates
Cavity in LUL

18. • Caseous necrosis occurs centrally within the lung parenchymal
opacity, decreasing its size.
• The lung opacity tends to become rounded with healing, and it
continues to shrink until only a small nodule remains.
• Subsequently, the nodule may become calcified or ossified, resulting
in a calcified granuloma.

19. Radiological Findings In Primary Infection
• Lymphadenopathy is a common
manifestation of primary pulmonary
tuberculosis
• The presence of hilar and mediastinal
lymphadenopathy may distinguish primary
from postprimary tuberculosis, because
lymphadenopathy is conspicuously absent in
postprimary tuberculosis
• Lymphadenopathy without a parenchymal
opacity may occur as the only manifestation
of primary pulmonary tuberculosis. Most
commonly, this is seen in the population
with HIV infection

20. • Lymphadenopathy is most common in
the ipsilateral hilar region.
• Hilar lymphadenopathy is seen in
approximately 60% of children with
primary tuberculosis,
• paratracheal adenopathy is seen in
40%, and
• subcarinal lymphadenopathy is seen
in 80%.

21. • The pattern of lymphadenopathy is
indistinguishable from that of sarcoidosis
or lymphoma
• Lymphadenopathy may be symptomatic if
it secondarily involves the airways.
• With an appropriate immune response or
with adequate chemotherapy, enlarged
necrotic lymph nodes may diminish in
size and commonly calcify.
• The presence of calcified lymph node
and a granuloma represents the Ranke
complex.

22. • Pleural effusion – uncommon in infants and
young children
• Prevalence increases with age
• Usually unilateral on same side as the site of
initial infection
• May be only radiologic finding indicative of
primary TB (5%)

23. • Airway Involvement -frequently present in primary tuberculosis
• Involved in one of the following ways:
• Airway compression by adjacent lymphadenopathy with resultant atelectasis
• Mucosal infection with resultant ulceration and long-term stricture formation
• Broncholithiasis, ie, extrinsic erosion of a bronchus by adjacent
lymphadenopathy with extrusion of calcified material into the bronchus
• Endobronchial spread of infection
• Bronchiectasis

24. • Atelectasis is most notable within the anterior segments of the upper
lobes and the medial segment of the middle lobe
• Atelectasis may resolve as lymphadenopathy regresses

25. • The endobronchial spread of infection may be seen with tuberculous
tracheobronchial disease.
• Bacilli from the infected airways disseminate into more distal bronchi
and bronchioles and subsequently enter the alveoli, where they
become deposited.
• The resultant radiographic appearance is one of small ill-defined
acinar shadows and small nodules

26. Role Of CT In Primary TB
• Helps confirm the presence of
- An ill-defined parenchymal infiltrate.
- Lymphadenopathy.
- Involvement of tracheobronchial tree.
- Bronchioliths –can be identified in rare cases.
- Mediastinitis and even mediastinal abscesses

27. -Small pleural effusions are detected more readily on CT scans than on
other images.
-Contrast enhancement may be useful in identifying evolution into an
empyema
• Lymphadenopathy causing bronchial compression can be identified
on CT scans, and airway compromise can be monitored during
chemotherapy.
• Central hypoattenuation with peripheral rim enhancement in CECT
reflects central necrosis within the node.

28. Radiological Findings In Post-Primary PTB
• Parenchymal manifestations
• Airway involvement
• Pleural involvement
• Lymphadenopathy: Absent except in HIV/AIDS

29. Radiological Findings In Post-Primary PTB
• Parenchymal manifestations
• Patchy or confluent airspace opacities
• Involve the apical and posterior segments of the
upper lobes and the superior segments of the
lower lobes.
• Cavitary disease is secondary to caseous
necrosis within the opacity
• The debris from the lesion is expelled via the
tracheobronchial tree with which the cavity is in
communication

30. Extensive parenchymal involvement

31. • Cavitation in 40-50 %
• Radiologic hallmark of reactivation TB
• Cavitary disease is secondary to caseous
necrosis within the opacity
• The debris from the lesion is expelled via the
tracheobronchial tree with which the cavity is in
communication
• Cavities are also commonly seen within the
upper lung zones
• The cavities demonstrate a thick outer wall with
a smooth inner contour.
• Air-fluid levels may be present.

32. LUL cavities ,RUL infiltrate ,Bilateral upper
lobe disease
RUL cavity ,Posterior segment

33. • Cavitation can also cause
pseudoaneurysms of the
pulmonary artery, which
are called Rasmussen
aneurysms
Selective bronchial arteriogram in a patient with history of
tuberculosis who presented with massive hemoptysis. This
image reveals a Rasmussen aneurysm (left) that was
embolized right).

34. • Superinfection by Aspergillus
organisms may occur, leading
to a mycetoma
Aspergilloma: a rounded soft tissue mass is
seen within a cavity in the left upper lobe
with an air crescent adjacent to the mass.

35. • Airway Involvement
• Bronchial stenosis may result in atelectasis
in the segments of the lung supplied by
that bronchus
• Bronchiectasis may occur. Dilated bronchi
may be irregular in caliber and may appear
as varicoid or tram track or may be cystic.
• Traction bronchiectasis may occur as well,
as a consequence of fibrosis.

36. Bronchiectatic changes

37. • Lymphadenopathy – uncommon, 5%
• Pleural effusion – 16-18 %,
-typically unilateral
-Seen more commonly in postprimary
tuberculosis than in primary infection.
-Pleural effusions may occur and may
progress to empyema
-Infection may extend from the pleural
space to involve the chest wall (empyema
necessitans)
-Osseous destruction and, possibly, air
within subcutaneous tissues may be
identified radiographically, or the empyema
may present as a palpable soft-tissue mass

38. • Pleural effusion although accompanied by parenchymal abnormalities, may
be the sole imaging manifestation.
• Determination of pleural fluid ADA level can be helpful.
• New subpleural lung nodules may develop during medication for tubercular effusion,
and should not be regarded as treatment failure – eventually show improvement with
continued medication

39. • Endobronchial Spread
• Occurs as a consequence of infected material passing into the
tracheobronchial tree from an infected portion of the lung
• The organisms pass via the airways into previously uninvolved
portions of the lung.
• The radiographic appearance is one of widespread ill-defined acinar
shadows.
• Foci may become confluent and mimic bacterial pneumonia.
• Spread from the upper lobes to the lower lobes is common and
called the upstairs-downstairs pattern.

40. • Centrilobular small nodules, branching linear
and nodular opacities (tree in bud sign), patchy
or lobular areas of consolidation, and cavitation.
• Centrilobular small nodules and tree-in-bud sign
reflect the presence of endobronchial spread
• Tree-in-bud signs – considered a reliable marker
of the activity of the process.
• Cavitation is also a sign of active disease process
and usually heals as a linear or fibrotic lesion.

41. This image demonstrates extensive bilateral lung nodules and a
cavity in a partially collapsed right upper lung. Sputum cultures
were positive for tuberculosis. The nodules indicate
endobronchial spread of the tuberculosis

42. • Tuberculomas 3-6%
• Are rounded discrete nodules that are known to
harbor bacilli.
• They may be present in primary or postprimary
tuberculosis.
• Radiographically appear as Round or oval, sharply
marginated lesions usually measuring 5-40 mm,
typically within the upper lobes.
• Tuberculomas may calcify.
• Satellite lesions (ie, small discrete nodules in the
vicinity of the tuberculoma) are present in as many
as 90% of patients

43. Role Of CT In Post Primary TB
• CT scans may be helpful in evaluating
• parenchymal involvement
• satellite lesions
• bronchogenic spread of infection
• miliary disease

44. • Cavitation is best demonstrated on CT
scans.
• The outer wall of the cavity tends to
be thick walled and irregular, whereas
the inner wall tends to be smooth.
• An air-fluid level may be identified.
• The connection of the cavity to the
airway may be visualized.
• Complications of cavitary disease may
become apparent with mycetoma
formation, which appears as an
intraluminal collection of material
with a crescent of surrounding air.
CT scan obtained with the pulmonary window
setting in the right upper lobe shows an
irregular, thick-walled cavity with some
increased markings around it. A nearby nodule
is also

45. Aspergilloma
Extensive TB

46. • CT is the examination of choice for evaluating the tracheobronchial tree
• Lymphadenopathy is a feature of primary infection; however, calcified
lymph nodes may cause persistent extrinsic compression on the bronchi
• Bronchial stenosis is more common in postprimary disease than in primary
tuberculosis
• Bronchiectasis, a well-known sequela of postprimary disease, tends to
occur in the upper lobes and often manifests as traction bronchiectasis on
the basis of fibrotic disease with subsequent traction on the airways.
• Recurrent infections and hemoptysis may result from traction
bronchiectasis.

47. • Empyema is visualized on contrast-enhanced CT scans
with enhancement of the parietal and visceral pleurae.
• Empyemas demonstrate the so-called split pleura sign.
• This sign consists of the pleural fluid collection tracking
between the abnormally enhancing parietal and
visceral pleura
• Spontaneous pneumothorax is an uncommon
complication of disease, may be secondary to
peripherally located lesions.
• Involvement of the pericardium and spine may be
demonstrated on CT images
Tuberculous Empyema

48. • Tuberculomas can be identified on CT scans as rounded nodules that
usually have surrounding associated satellite lesions.
• The bronchogenic spread of tuberculosis is recognized on CT scans by
the presence of acinar shadows and nodules of varying sizes in a
peribronchial distribution. The lesions are seen throughout both
lungs.

49. Miliary Tuberculosis
• Widespread dissemination by hematogenous route.
• 2-6% of primary TB, more frequently in post-primary
TB.
• In post-primary TB, may be seen in association with
typical parenchymal changes (consolidation,
cavitation, calcified lymph nodes, lymphadenopathy)
– 30%
• Characteristic radiographic findings: innumerable, 1-
3 mm, non-calcified nodules scattered throughout
both lungs, with mild basilar predominance

50. • Each focus of miliary infections
results in local granuloma – later
may show central caseous necrosis.
• Normal radiographic findings in
early stages – may not be visible
until 3-6 wks after hematogenous
spread

51. Role Of CT In Miliary TB
• CT – can demonstrate early than
radiography
• May demonstrate thickening of interlobular and
intralobular septa frequently.
• Diffuse or localized ground glass opacities
sometimes seen.
• CT scans may aid in the evaluation of
uncommon complications of miliary
tuberculosis, eg, adult respiratory distress
syndrome (ARDS) and pulmonary hemorrhage
resulting from disseminated intravascular
coagulopathy.
• Both ARDS and pulmonary hemorrhage may
manifest as alveolar filling in a background of
miliary nodules

52. Airway TB
• Most common cause of inflammatory stricture of
bronchus
• 10-20% of all PTB
• Principal CT findings – circumferential wall thickening
and luminal narrowing with involvement of long
segment of the bronchi.
• Active TB: irregularly narrowed lumen with thick
walls; both main bronchi
• Fibrotic disease: smoothly narrowed lumen with thin
walls; left main bronchus usually
• Associated parenchymal opacities and atelectasis.

53. TB IN HIV/AIDS
• Mycobacterial infection is common in HIV patients.
• In early stages of HIV infection, appearance is similar to reactivation
TB in normal population
• Later stages, appearance is more similar to primary TB

54. • In late disease:
• (1) patients often have a negative tuberculin
skin test reaction;
• (2) more than half will have extrapulmonary
(especially lymph node) involvement; and
• (3) upper-lobe cavitary disease is infrequent
and the chest radiographs are usually atypical
Chest radiograph obtained in a 28-year-old
HIV-seropositive man shows consolidation
in the left upper lobe associated with
mediastinal (double arrows) and left hilar
(single arrow) lymphadenopathy.

55. • Cavities are rare in AIDS patients
• Lymphadenopathy is common
• In the lung parenchyma:
• Non specific areas of pulmonary consolidation
• Round or branching pulmonary nodules
• Diffuse bilateral coarse reticulonodular opacities are typically demonstrated
• Mid- or lower-lobe predominance of lesions
• Disseminated TB is common in AIDS
• Milliary TB may be seen.
• High prevalence of pleural effusion

56. • Radiographic manifestations dependent on the
level of immunosuppression
• Intact cellular immunity – findings similar to those
of non-HIV infected
• In severe immunosuppression – may have normal
radiographs, or findings associated with primary
disease regardless of prior TB exposure

57. • HAART – considerably improved the outcome of HIV positive patients,
and also reduced the prevalence of opportunistic infections
• However, HIV associated TB still continues to occur even with using
HAART
• HAART may paradoxically worsen TB manifestations

58. • Unusual or atypical manifestations are common in patients with
impaired host immunity.
• Higher prevalence of multiple cavities and of nonsegmental distribution
• Atypical manifestations such as subpleural nodules or a lobar or
segmental airspace consolidation (may mimic lung cancer or bacterial
pneumonia) – common in pts with idiopathic pulmonary fibrosis.

59. MDR TB
• Fatal disease
• Major concerns – fear of spread of drug resistant organisms and
ineffectiveness of chemotherapy in patients infected with the resistant
organisms
• Imaging findings do not basically differ; however, multiple cavities and
findings of chronicity, such as bronchiectasis and calcified granulomas are
more common
• Strong correlation exists between imaging findings and the mode of
acquisition of drug-resistance
• Primary drug resistance (MDR TB without h/o chemotherapy or therapy h/o <1 month)
– noncavitary consolidation, pleural effusion, and a primary TB pattern of disease
• Acquired MDR TB after h/o chemotherapy >1 month – cavitary consolidations, in
general reactivation pattern of disease.

60. Multidrug-resistant tuberculosis in 36-yearold man. Posteroanterior chest radiograph shows
multiple small nodules, patchy consolidation containing several cavities, and linear opacities in both
lungs. Note decreased volume in right lung and apical pleural thickening.

61. Complications

63. Late Complications
• Interstitial fibrosis can cause pulmonary insufficiency and secondary
pulmonary artery hypertension
• Mycetoma formation
• Hemoptysis secondary to bronchiectasis
• Bronchiostenosis
• Broncholithiasis-erosion of a calcified peribronchial lymphnode into a
bronchus.
• Empyema
• Arterial pseudoaneurysm
• Bronchopleural fistula

64. • Diagnosis of TB
• Correct diagnosis in 91% and correct exclusion in 76% by CT, Vs 49% by
radiographs.
• Particularly helpful in detection of small foci of cavitation in areas of confluent
pneumonia and in areas of dense nodularity and scarring.
• Determining disease activity
-Disease activity is monitored by periodic radiographs, the appearance of new
lesions or the extension of old ones indicating continued activity, whereas
contraction indicates that the balance has been tilted in favour of healing.
-Once the radiographic signs have stabilised, any subsequent change in size or
density must be regarded as suspicious of reactivation, fungal colonisation or
complication by neoplasm

65. • Evaluation of pleural complications
• Effusion, empyema, and bronchopleural fistula
• Management of TB
• Locate the site of cavitation and the extent of active disease and thus can be a
roadmap for the planning of surgical treatment

66. Response To Treatment
• Best assessed by means of repeated sputum examinations in pts with +
bacteriology
• Radiographic evaluation is of lesser importance, although a baseline radiograph at
the completion of treatment may be useful for future comparison purposes
• In sputum –ve PTB pts, radiographic and clinical evaluation become the major
indicators of response to therapy, thus most common method used in children
(bacteriological confirmation possible in 1/3rd of cases)
• Regression of radiographic abnormalities – slow process
• First 3 months of Rx – worsening of radiographic findings, however, failure of
radiographic findings to improve after 3 months suggest drug-resistance or
superimposed process.
• Resolution of parenchymal abnormalities – 6 mnths – 2 yrs on radiographs and upto
15 mnths on CT
• Lymphadenopathy may persist for several years after treatment

67. Role Of Intervention
• Ultrasonography- or CT-guided thoracentesis
• Percutaneous lymph node aspiration or biopsy to obtain material for
culture, cytologic, or histologic studies.
• Diagnostic and therapeutic bronchial artery studies.
• Stent placement with fluoroscopic and/or CT guidance in
collaboration with the bronchoscopist.

68. Active Vs Inactive TB
• It must be remembered that assessments of the activity of TB cannot
be made accurately on the basis of a single radiograph alone.
• If there is any question of active TB, sputum smears must be obtained

69. Chest X-Ray Findings that Can Suggest ACTIVE
TB
1. Infiltrate or consolidation: Consolidation or infiltrate can be dense
or patchy and might have irregular, ill-defined, or hazy borders.
2. Any cavitary lesion: cavity can be thin or thick walled, with or
without irregular margins that might be surrounded by an area of
airspace consolidation or infiltrates, or by nodular or fibrotic
(reticular) densities, or both.
3. Nodule with poorly defined margins (Tuberculomas)
4. Pleural effusion
5. Hilar or mediastinal lymphadenopathy
6. Miliary TB.

70. Primary Post-primary
Consolidation (lower lobes superior segment) Consolidation (apical and superior segment of
the upper lobe and superior segment of the
upper lobe) Cavitation (restricted site )
Cavitation uncommon Cavitation common
Adenopathy + Adenopathy less common
Effusion (pleural, pericardial) less common Effusion (pleural, pericardial) less common
Miliary tuberculosis less common Miliary tuberculosis more common
Less common Endobronchial lesion + sequelae
(stenosis/bronchiectasis) more common

71. Chest X-Ray Findings that Can Suggest
INACTIVE TB:
1. Discrete fibrotic scar or linear opacity: The edges of
these densities should be distinct and there should
be no suggestion of airspace opacification or haziness
between or surrounding these densities.
2. Discrete nodule(s) without calcification: One or
more nodular densities with distinct borders and
without any surrounding airspace opacification.
3. Discrete fibrotic scar with volume loss or retraction
4. Discrete nodule(s) with volume loss or retraction
5. Any other finding suggestive of prior TB, such as
upper lobe bronchiectasis
6. Cavities with intracavitary bodies.

72. Primary Post-primary
Inactive Normal radiograph Normal radiograph
Scarring (any site) + sequelae Scarring (restricted) +
sequelae
Calcification (nodes, lung) Calcification (nodes,
lung, pleura)
Restricted site = mainly apical and posterior segments
of the upper lobes and superior segments of the lower lobes

74. References
• Textbook of Radiology & Imaging- David Sutton 7th edition
• Fundamentals of Diagnostic Radiology - Bryant & Helms - 4Ed
• Diagnostic Radiology- Grainger & Allison's 6Ed
• Other sources from internet