Introduction:

The diagnosis of pulmonary tuberculosis (PTB) can be difficult in some cases and then the use of other techniques including chest CT is necessary.

The aim of this study was to determine the indications and the utility of CT scan findings in the management of PTB.

Methods:

We have retrospectively reviewed cases of PTB seen on the recent 5 years between 2017 and 2022 in the pulmonology department (2) of Abderrahmen Mami Hospital in Ariana, TUNISIA

Results:

There were 70 male patients with a mean age of 43 years [15-69]. The diagnosis of active PTB was based on positive acid-fast bacilli in sputum in 60 patients (85,7%). CT scan was performed in 26 patients (37,1%) and allowed evoking the diagnosis in nine patients with negative BK sputum smear.

When compared with patients who had only a chest X Ray as a radiological finding, Patients who had a CT scan described less productive cough (p=0,04) and less nocturnal sweats (p= 0,03) but more dyspnea (p=0,004). They also had fewer multiple tuberculosis risk factors (p=0,08).

Typical CT findings of active PTB including association of centrilobular nodules, branching linear structures (tree-in-bud appearance) and cavitation were observed in 16 patients.

The other CT scan findings were: pseudo-pneumonic appearance in 6 cases, tumour-like appearance (tuberculoma) in 2 cases and miliary tuberculosis in 2 cases. In 3 cases, CT scan showed Rasmussen aneurysm complicating a pulmonary active tuberculosis

Conclusion:

CT scan retains a place in the diagnostic strategy of pulmonary tuberculosis. It is useful for the diagnosis of pulmonary tuberculosis in negative sputum smear patients. By contrast, it is unclear whether it is useful for post-treatment follow-up of this disease.