TMSS Medical College Journal

Background: Pulmonary tuberculosis (PTB) is a common lung infection in Bangladesh. Despite advancement in diagnostic methods, chest x-ray remains as mainstay of investigation. Radiographic manifestations of PTB are diverse and varied. To describe the various pattern of chest x-ray in smear positive tuberculosis patient in northern territory of Bangladesh was the objective of the study. Materials & Methods: A hospital based cross-sectional study was conducted at the TB clinic, Bogura. Total 133 smear positive PTB patients were consecutively interviewed and interpreted. Results: Chest X-ray finding was found variable and overlapping. Around one fourth (24%) patient had more than one findings and frequency of overlapping findings were consolidation (46%), large inhomogeneous opacity (26%), patchy opacity (20%), fibrosis (26%), dense homogenous opacity with air bronchogram (6%), bronchiectasis (6%), nodular opacity (12%), collapse (6%), cavity (9.77%), pleural effusion (2%).Twelve percent patient had found normal chest x-ray. Radiological lesion were found right lung (33%), left lung (26%) and in both lung in 29% cases and no lesion were seen in 12%. Scrutinizing in all cases upper & upper-middle zone involvement was most common and it was found in 55% cases. On the contrary, only lower zone involvement, only middle zone involvement, all zone involvement and no involvement was seen in 18%, 3%, 2% and 12% respectively. Conclusion: Smear positive pulmonary tuberculosis most commonly presents with upper and upper-middle zone consolidation and thereafter as a parenchymal involvement.

Tuberculosis (TB), the oldest infectious disease, a public health problem has become one of the top ten causes of death in worldwide. According to World Health Organization (WHO) statistics, in 2016, 10.4 million people fell ill with TB, and 1.7 million died from the disease (including 0.4 million among people with HIV)® and therefore it ranks as second major cause of adult mortality from an infectious disease worldwide, after human immunodeficiency virus (HIV).>* Among all, low- and middle-income countries suffered from over 95% burden.** Surprisingly, Bangladesh (one of 30 ‘high TB-burden’ countries), accounts for a disproportionately higher number of TB cases with annual occurrence of 362,000 new TB cases and costs for >73, 000 people annually.® In clinical practices, TB particularly pulmonary tuberculosis (PTB), is frequently encountered but rapid diagnosis and early PTB detection continues to be challenging for clinicians.” Over decades, many tools have been invented; still no single tools are satisfactory mostly due to lack of sensitivity and specificity.* Anyone with a cough that lasts >2 weeks with unexplained chronic fever and/or weight loss should be evaluated for TB." Sputum microscopy is an essential step in the investigation of patients who are suspected of PTB.''” Besides microscopy and other new technique, chest x-ray has been a part of TB diagnosis for over a century." Radiological presentation of TB may be variable in chest x-ray but in many cases is quite characteristic.'