Skip to main content

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

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

Abbreviations

CT:

Computed tomography

HRCT:

High-resolution computed tomography

M:

Mycobacteria

MAC:

Mycobacterium avium complex

NTM:

Nontuberculous mycobacteria

TB:

Tuberculosis

References

  1. Verschakelen JA, De Wever W. Computed tomography of the lung. Berlin, Heidelberg, New York: Springer; 2018.

    Book  Google Scholar 

  2. Remy-Jardin M, Beuscart R, Sault M, Marquette C, Remy J. Subpleural micronodules in diffuse infiltrative lung diseases: evaluation with thin section CT scans. Radiology. 1990;177:133–9.

    CAS  Article  Google Scholar 

  3. Raoof S, Amchentsev A, Vlahos I, Goud A, Naidich DP. Pictorial essay: multinodular disease—a high-resolution CT scan diagnostic algorithm. Chest. 2006;129:805–15.

    Article  Google Scholar 

  4. Collins J, Blankenbaker D, Stern EJ. CT patterns of bronchiolar disease: what is tree-in-bud? AJR Am J Roentgenol. 1998;171:365–70.

    CAS  Article  Google Scholar 

  5. Gallardo X, Castaner E, Mata J, et al. Nodular pattern at lung computed tomography in fat embolism syndrome. A helpful finding. J Comput Assist Tomogr. 2006;30:254–7.

    Article  Google Scholar 

  6. Colby TV, Swensen SJ. Anatomic distribution and histopathologic patterns in diffuse lung disease: correlation with HRCT. J Thorac Imaging. 1996;11:1–26.

    CAS  Article  Google Scholar 

  7. Voloudaki AE, Tritou IN, Magkanas EG, et al. HRCT in miliary lung disease. Acta Radiol. 1999;40:451–6.

    CAS  Article  Google Scholar 

  8. Kim TS, Koh WJ, Han J, Chung MJ, Lee JH, Lee KS, et al. Hypothesis on the evolution of cavitary lesions in nontuberculous mycobacterial pulmonary infection: thin-section CT and histopathologic correlation. AJR Am J Roentgenol. 2005;184(4):1247–52.

    Article  Google Scholar 

  9. McEvoy S, Lavelle L, Kilcoyne A, McCarthy C, deJong PA, Loeve M, et al. High-resolution CT of nontuberculous mycobacterium infection in adult CF patients: diagnostic accuracy. Eur Radiol. 2012;22(12):2736–42.

    Article  Google Scholar 

  10. Polverosi R, Guarise A, Balestro E, Carloni A, Dalpiaz G, Feragalli B. High-resolution CT of nontuberculous mycobacteria pulmonary infection in immunocompetent, non-HIV-positive patients. Radiol Med. 2010;115(2):191–204.

    CAS  Article  Google Scholar 

  11. Kwak N, Lee CH, Lee HJ, Kang YA, Lee JH, Han SK, et al. Non-tuberculous mycobacterial lung disease: diagnosis based on computed tomography of the chest. Eur Radiol. 2016;26(12):4449–56.

    Article  Google Scholar 

  12. Jeong YJ, Lee KS, Koh WJ, Han J, Kim TS, Kwon OJ. Nontuberculous mycobacterial pulmonary infection in immunocompetent patients: comparison of thin-section CT and histopathologic findings. Radiology. 2004;231(3):880–6.

    Article  Google Scholar 

  13. Lee KS, Kim TS, Han J, Hwang JH, Yoon JH, Kim Y, et al. Diffuse micronodular lung disease: HRCT and pathologic findings. J Comput Assist Tomogr. 1999;23(1):99–106.

    CAS  Article  Google Scholar 

  14. Ko JM, Park HJ, Cho DG, Kim CH. CT differentiation of tuberculous and non-tuberculous pleural infection, with emphasis on pulmonary changes. Int J Tuberc Lung Dis. 2015;19(11):1361–8.

    CAS  Article  Google Scholar 

  15. Klein E. Contributions to the normal and pathological anatomy of the lymphatic system of the lungs. Proc R Soc Lond. 1874;22:133–45.

    Google Scholar 

  16. Basaraba RJ, Smith EE, Shanley CA, Orme IM. Pulmonary lymphatics are primary sites of Mycobacterium tuberculosis infection in guinea pigs infected by aerosol. Infect Immun. 2006;74(9):5397–401.

    CAS  Article  Google Scholar 

  17. Behr MA, Waters WR. Is tuberculosis a lymphatic disease with a pulmonary portal? Lancet Infect Dis. 2014;14(3):250–5.

    Article  Google Scholar 

  18. Pereira M, Gazzoni FF, Marchiori E, Irion K, Moreira J, Giacomelli IL, et al. High-resolution CT findings of pulmonary Mycobacterium tuberculosis infection in renal transplant recipients. Br J Radiol. 2016;89(1058):20150686.

    Article  Google Scholar 

  19. He W, Chen BD, Lv Y, Zhou Z, Xu JP, Lv PX, et al. Use of low-dose computed tomography to assess pulmonary tuberculosis among healthcare workers in a tuberculosis hospital. Infect Dis Poverty. 2017;6(1):68.

    Article  Google Scholar 

  20. Kienzl-Palma D, Prosch H. Thoracic manifestation of tuberculosis. Radiologe. 2016;56(10):866–73.

    CAS  Article  Google Scholar 

  21. McGuinness G, Naidich DP, Jagirdar J, Leitman B, McCauley DI. High resolution CT findings in miliary lung disease. J Comput Assist Tomogr. 1992;16:384–90.

    CAS  Article  Google Scholar 

  22. Chu H, Li B, Zhao L, Huang D, Xu J, Zhang J, et al. Tree-in bud pattern of chest CT images for diagnosis of Mycobacterium abscesses. Int J Clin Exp Med. 2015;8(10):18705–12.

    PubMed  PubMed Central  Google Scholar 

  23. Schiff HF, Jones S, Achaiah A, Pereira A, Stait G, Green B. Clinical relevance of non-tuberculous mycobacteria isolated from respiratory specimens: seven year experience in a UK hospital. Sci Rep. 2019;9(1):1730.

    CAS  Article  Google Scholar 

  24. Yasin H, Mangano WE, Malhotra P, Farooq A, Mohamed H. Hot tub lung: a diagnostic challenge. Cureus. 2017;9(8):e1617.

    PubMed  PubMed Central  Google Scholar 

  25. Kim C, Park SH, Oh SY, Kim SS, Jo KW, Shim TS, et al. Comparison of chest CT findings in nontuberculous mycobacterial diseases vs. Mycobacterium tuberculosis lung disease in HIV-negative patients with cavities. PLoS One. 2017;12(3):e174240.

    Article  Google Scholar 

  26. Yuan MK, Chang CY, Tsai PH, Lee YM, Huang JW, Chang SC. Comparative chest computed tomography findings of non-tuberculous mycobacterial lung diseases and pulmonary tuberculosis in patients with acid fast bacilli smear-positive sputum. BMC Pulm Med. 2014;14:65.

    Article  Google Scholar 

  27. Kuhlman JE, Deutsch JH, Fishman EK, Siegelman SS. CT features of thoracic mycobacterial disease. Radiographics. 1990;10:413–31.

    CAS  Article  Google Scholar 

  28. Uitenbroek DG. SISA Exact test. 1997. https://www.quantitativeskills.com/sisa/statistics/fiveby2.htm. Accessed 18 Feb 2020.

  29. Ko JM, Park HJ, Kim CH. Clinicoradiologic evidence of pulmonary lymphatic spread in adult patients with tuberculosis. AJR Am J Roentgenol. 2015;204(1):38–43.

    Article  Google Scholar 

  30. Mehta AR, Mehta PR, Mehta RL. A cough conundrum in a patient with a previous history of BCG immunotherapy for bladder cancer. BMJ Case Rep. 2012;24:2012.

    Google Scholar 

  31. Marusić A, Katalinić-Janković V, Popović-Grle S, Janković M, Mazuranić I, Puljić I, et al. Mycobacterium xenopi pulmonary disease—epidemiology and clinical features in non-immunocompromised patients. J Infect. 2009;58(2):108–12.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ante Marušić.

Ethics declarations

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.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Author Contribution

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.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00508-020-01701-1

Keywords

  • Multidetector computed tomography
  • Multiple pulmonary nodules
  • Nontuberculous mycobacteria
  • Lymph
  • Mycobacterium tuberculosis