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Nodular distribution pattern on chest computed tomography (CT) in patients diagnosed with nontuberculous mycobacteria (NTM) infections

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Summary

Background

This study evaluated the prevalence of spreading pathways in nontuberculous mycobacteria (NTM) pulmonary infections according to nodular distribution patterns seen on chest computed tomography (CT).

Methods

This study included 63 patients diagnosed with NTM lung infections who underwent CT at our institution. A retrospective analysis of CT images focused on the presence and distribution of nodules, presence of intrathoracic lymphadenopathy and the predominant side of infection in the lungs. The findings were classified into five groups; centrilobular (bronchogenic spread), perilymphatic (lymphangitic spread), random (hematogenous spread), combined pattern and no nodules present. The groups were then compared according to other CT findings.

Results

Among 51 (81%) patients identified with a nodular pattern on chest CT, 25 (39.8%) presented with centrilobular, 7 (11.1%) with perilymphatic, 6 (9.5%) with random and 13 (20.6%) with combined nodular patterns but located in different areas of the lungs. The right side of the lungs was predominant in 38 cases (60.3%). Intrathoracic lymphadenopathy was evident in 20 patients (31.7%). Significant differences in distributions of nodular patterns were seen in patients infected with Mycoplasma avium complex (MAC) associated with centrilobular pattern (p = 0.0019) and M. fortuitum associated with random pattern (p = 0.0004). Some of the findings were related to perilymphatic nodules between other isolated species of NTM (p = 0.0379).

Conclusion

The results of this study showed a high proportion of perilymphatic nodules and right-sided predominance in the upper lobe, which, combined with intrathoracic lymphadenopathy is highly suggestive of the lymphangitic spread of lung NTM infections.

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Abbreviations

CT:

Computed tomography

HRCT:

High-resolution computed tomography

M:

Mycobacteria

MAC:

Mycobacterium avium complex

NTM:

Nontuberculous mycobacteria

TB:

Tuberculosis

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Authors and Affiliations

  1. Department of Radiology, Thoracic radiology, University Hospital Center, University of Zagreb Medical School, Kišpatićeva 12, 10 000, Zagreb, Croatia

    Ante Marušić, Ivana Kuhtić & Ivica Mažuranić

  2. Department for Respiratory Diseases, University Hospital Center, University of Zagreb Medical School, Kišpatićeva, Zagreb, Croatia

    Mateja Janković & Goran Glodić

  3. Division of Molecular medicine, Laboratory of Molecular Virology and Bacteriology, Ruder Boskovic Institute, Bijenička cesta, Zagreb, Croatia

    Ivan Sabol

  4. Emergency Department of Zagreb County, Matice Hrvatske, Zagreb, Croatia

    Lucija Stanić

Authors
  1. Ante Marušić
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  2. Ivana Kuhtić
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Correspondence to Ante Marušić.

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Conflict of interest

A. Marušić, I. Kuhtić, I. Mažuranić, M. Janković, G. Glodić, I. Sabol, and L. Stanić declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. This is a retrospective study. For this type of study, formal consent is not required, because no personal data were contained and there was no concern about identifying information.

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All authors contributed to the study conception and design. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Marušić, A., Kuhtić, I., Mažuranić, I. et al. Nodular distribution pattern on chest computed tomography (CT) in patients diagnosed with nontuberculous mycobacteria (NTM) infections. Wien Klin Wochenschr 133, 470–477 (2021). https://doi.org/10.1007/s00508-020-01701-1

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