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Answer to your Health Question

Question (03/12 /2012):

Title: Hilar adenopathy and tuberculosis.

Thanks a lot for reply.

I am going through suggested answers.

I just have one more question:

Is there any chance of tuberculosis from given x ray report?

Shall I go for TB sputum/smear test?

*Suspicious subtle Left Hilar Prominence noted. *

*Horizontal Fissure is seen Right diaphragmatic humping with bilateral scalloping is noted *

*Otherwise, both lung fields and pleural appear clear *

*Cardiac size is normal Aorta and right hilum appear normal *

*Bony thorax is normal*



Dear Noor,

The differential diagnosis of unilateral or asymmetric hilar adenopathy includes infections [primary tuberculosis (Primary TB, is classically described in children), fungi such as histoplasma, and bacteria such as tularemia or anthrax] and neoplasia (lymphoma or metastatic malignancy such as lung, breast,renal, melanoma).

Tuberculosis (TB) in adults is generally not associated with hilar adenopathy.

In adults, TB is usually due to reactivation of prior disease and is characterized by multifocal cavitary infiltrates in the upper lobes, granuloma formation, and healing with fibrosis.

However, in patients with disorders of cell-mediated immunity such as AIDS, reactivation TB can have an appearance similar to primary TB (lobar infiltrate and hilar adenopathy).

The results from a chest x-ray cannot confirm that a person has TB disease.

The simplest laboratory test is the examination of sputum for the detection of acid-fast bacilli (AFB).

However, it only identifies 35% of patients with active TB.

This test will also identify acid fast bacilli other than M. tuberculosis so its specificity is not 100%.

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