The Radiological Spectrum of Pulmonary Multidrug-Resistant Tuberculosis in HIV-Negative Patients

Background: Multidrug-resistant tuberculosis (MDR-TB) is a major worldwide health problem. In countries where TB is of moderate to high prevalence, the issue of MDR-TB carries significant importance. MDR-TB, similar to drug-sensitive TB, is contagious. Meanwhile its treatment is not only more difficult but also more expensive with lower success rates. Regarding clinical findings, there is no significant difference between MDR-TB and drug-sensitive TB. Therefore determination of characteristic radiological findings in cases of MDR-TB might be of help in early detection, and hence appropriate management of this disease condition. Objective: To explain the radiological spectrum of pulmonary MDR-TB. Patients and Methods: We retrospectively evaluated the radiographic images of 35 patients with clinically- and microbiologically-proven MDR-TB admitted to our tertiary-care TB unit over a period of 13 months. The latest chest X-ray of all patients and the conventional chest CT scan without contrast of 15 patients were reviewed by three expert radiologists who rendered consensus opinion. Results: Of the 35 patients with imaging studies, 23 (66%) were male and 12 (34%) were female. The mean±SD age of participants was 38.2±17.3 (range: 16–80) years. 33 patients were known as secondary and only 2 had primary MDR-TB. Chest radiography revealed cavitary lesion in 80%, pulmonary infiltration in 89% and nodules in 80% of the cases. Pleurisy was the rarest finding observed in only 5 (14%) patients. All of 15 chest CT scans revealed cavitation, 93% of which were bilateral and multiple. Pleural involvement was seen in 93% of patients. Conclusion: Presence of multiple cavities, especially in both lungs, nodular and infiltrative lesions, and pleural effusion are main features of MDR-TB as compared to drug-sensitive TB.