Aspectos tomográficos do tuberculose pulmonar em atividade e avaliação de sequelas após tratamento

• Autor(a) principal: Capone, Rafael Barcelos
• Data de Publicação: 2015
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/8827
• topic: Pulmonary tuberculosis; Diagnostic imaging; Computedtomography; Sequelae; Tuberculose pulmonar; Diagnóstico por imagem; Tomografia computadorizada; Sequelas; CNPQ::CIENCIAS DA SAUDE::MEDICINA

Tuberculosis (TB) remains a serious health problem. In Brazil around 71,000 new cases / year are reported with about 4,600 deaths, giving it a concentrated epidemic situation, according to the new classification proposed by WHO. The sputum smear microscopy (AFB), is still the main method of diagnosis, but is negative in a significant proportion of patients with active TB. Computed tomography (CT) may surprise early changes of the disease, assess more accurately the extent and determine a diagnosis standard based on fundamental alterations. Thus, the method is particularly useful in patients with suspected TB with negative AFB, allowing a therapeutic decision making pending the result of culture for evidence of the disease. Our objectives were to describe the main computed tomography findings of TB, assess its extent and establish the degree of agreement among three radiologists with expertise in tomographic diagnosis. We conducted a longitudinal study, retrospective and analytical of 74 patients with proven TB by sputum examination, which underwent CT of the chest before (TC1) and after (TC2) 6 months of treatment. CT scans were read by three radiologists oblivious to any data. Based on the observed changes, we attempted to establish a consistent pattern with active TB. The main findings of the TC1 consisted of parenchymal abnormalities characterized as airspace nodes configuring the tree-in-bud pattern in 93% of cases, ill-defined nodules measuring between 1 and 3 cm in diameter in 84%, consolidation and air bronchogram in 77% and 67%, respectively, in 71% architectural distortion, cavities 62% and ground glass opacity in 37%. There was bilateral involvement in 70% (52/74). The left lung was affected in isolation in 16% and the right lung 13.5%. Thickening of the bronchial walls and dilation was observed in 93% and approximation of the bronchi in 71%. Lymph nodes with diameters greater than 1.0 cm were observed in 24%. The pleural involvement occurred in 54% of cases have been characterized as pleural fluid in 55% and thickness in 45% . Active TB was an established diagnosis among the three readers in 85% of cases. The analysis of TC2 after 6 months of treatment showed significant decrease in the lesions compared to TC1 in all cases. In conclusion, it was possible to establish a tomographic pattern of active tuberculosis characterized by tree-in-bud, consolidations, architectural distortion and cavities that allowed a degree of agreement (Kappa) almost perfect (0.85) by the radiologists involved in the project. There were residual changes in most cases, probably related to the long time needed to diagnose tuberculosis which averaged, in this work,as long as 105.3 days.