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High-resolution CT of nontuberculous mycobacteria pulmonary infection in immunocompetent, non-HIV-positive patients

TC ad alta risoluzione nelle infezioni polmonari da micobatteri non tubercolari (NTM) in pazienti immunocompetenti (non HIV+)

  • Chest Radiology/Radiologia Toracica
  • Published:
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Abstract

Purpose

The objective of this study was to demonstrate that nontuberculous mycobacteria (NTM) pulmonary infections are not so infrequent and that the diagnosis may be suggested on the basis of the high-resolution computed tomography (HRCT) pattern alone.

Materials and methods

We retrospectively reviewed HRCT scans of 29 patients (9 men, 18 women; mean age 63 years, range 38–88 years) with positive culture from bronchial wash. Mycobacterium avium complex (MAC) was present in all (with the exception of one in whom the NTM was indistinct). In six patients, MAC was associated with M. chelonae, M. kansasii, M. fortuitum or M. xenopi. In one of these patients, MAC was associated with both M. fortuitum and M. chelonae. All patients had had nonspecific symptoms of pulmonary infection for a time ranging from 6 months to 12 years. Previous tuberculous infection was present in five patients (18.5%). Eleven patients had other pulmonary diseases (40.8%), and 12 had associated systemic diseases (44.4%).

Results

HRCT findings were apical fibrotic scarring (n=8; 29.6%), consolidations (n=16; 59.2%), single/multiple nodules >1 cm (n=8, multiple; 29.6%), cavitations (n=7; 25.9%), ground glass appearance (n=3; 11.1%), reticular/reticulonodular pattern (n=6; 22.2%), bronchiectasis (n=25; 92.5%), centrilobular nodules (tree in bud) (n=24; 88.8%), air trapping (n=8; 29.6%), lymphadenopathy >1 cm, also with calcification (n=13, 3 with calcification; 48.1%) and pleural effusion (n=2; 7.4%). In 3/7 patients with nodules >1 cm and with cavitations, the “feeding bronchus sign” (a patent bronchus running into a cavitation) was present. Lesions were in the upper lobes in 23 (85.1%), middle lobe/lingula in 25 (92.5%) and lower lobes in 18 (66.6%) patients. The findings were diffuse in 13 (48.1%) cases and patchy in 17 (62.9%).

Conclusions

HRCT findings are essential for the diagnosis of NTM pulmonary infection. The presence of bronchiectasis, cavitary nodules with feeding bronchus sign and tree-in-bud nodules in the middle lobe and lingula are suggestive of NTM infection, thus assisting the physician in the diagnostic workup of these patients.

Riassunto

Obiettivo

Scopo di questo lavoro è di dimostrare come l’infezione da micobatteri non tubercolari (NTM) non sia così infrequente e come sia possibile suggerirla al clinico e al microbiologo, a volte solo sulla base del pattern in tomografia computerizzata ad alta risoluzione (HRCT).

Materiali e metodi

Sono stati rivalutati retrospettivamente gli esami HRCT di 27 pazienti (9 maschi e 18 femmine; età media 63 anni, range 38–88 anni) con diagnosi microbiologica (esame colturale del broncoaspirato) di infezione da NTM. In tutti i pazienti era presente il M. avium complex (MAC), tranne in uno in cui il NTM è rimasto indefinito; in 6 pazienti vi era associazione di MAC con M. chelone, M. kansasii, M. fortuitum o M. xenopi. In uno di questi vi era l’associazione di MAC sia con M. fortuitum che M. chelone. In tutti erano presenti sintomi aspecifici di patologia polmonare (dispnea, tosse, a volte con escreato, febbre o febbricola, calo ponderale e astenia) con durata variabile da 6 mesi a 12 anni. Pregressa infezione tubercolare era presente in 5 pazienti (18,5%), 11 pazienti (40,8%) avevano fattori di rischio rappresentati da pre-esistenti malattie polmonari e 12 (44,4%) da malattie sistemiche, anche in associazione tra loro.

Risultati

I segni HRCT riscontrati sono stati esiti cicatriziali agli apici (8, 29,6%), addensamenti parenchimali (16, 59,2%), nodulo solitario/multipli con diametro >1 cm (8 multipli, 29,6%), cavitazioni dei noduli (7/8, 87,5%), vetro smerigliato (3, 11,1%), quadro reticolare/reticolo-nodulare (6, 22,2%), bronchiettasie (25, 92,5%), noduli centrolobulari (albero con gemme) (24, 88,8%), air trapping (8, 29,6%), linfonodi con diametro >1 cm ed eventuali calcificazioni (13, 3 con calcificazioni, 48,1%), versamento pleurico (2, 7,4%). In 3 dei 7 pazienti con noduli maggiori di 1 cm e con cavitazione è stato individuato il feedings bronchus sign, cioè la presenza di un bronco dilatato con pareti ispessite, a contatto con il nodulo escavato. Le lesioni interessavano i lobi superiori in 23 (85,1%), i lobo medio/lingula in 25 (92,5%) e i lobi inferiori in 18 (66,6%) pazienti. La diffusione delle lesioni è stata uniforme in 13 (48,1%) casi e a carta geografica in 17 (62,9%).

Conclusioni

Si può affermare che l’HRCT è metodica fondamentale nel riconoscimento e nella diagnosi di infezione polmonare da NTM. La presenza di bronchiettasie, di noduli escavati con il feedings bronchus sign e di noduli centrolobulari ad albero con gemme, con distribuzione prevalente nel lobo medio e nella lingula devono suggerire la possibilità di infezione da NMT, e orientare così il clinico verso la ricerca del germe responsabile.

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Authors and Affiliations

  1. Struttura Complessa di Radiologia, Ospedale S. Bassiano, Bassano del Grappa (VI), Via dei Lotti 40, 36061, Bassano del Grappa (VI), Italy

    R. Polverosi & A. Guarise

  2. Struttura Complessa di Pneumologia, Ospedale S. Bassiano, Bassano del Grappa (VI), Via dei Lotti 40, 36061, Bassano del Grappa (VI), Italy

    E. Balestro

  3. UO Radiologia Diagnostica ed Interventistica, Azienda Ospedaliera Santa Maria, Terni, Italy

    A. Carloni

  4. Strutture Complessa di Radiologia, Ospedale Bellaria, Bologna, Italy

    G. Dalpiaz

  5. Istituto di Radiologia, Ospedale SS Annunziata, Chieti, Italy

    B. Feragalli

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  1. R. Polverosi
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  2. A. Guarise
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  3. E. Balestro
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  4. A. Carloni
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  5. G. Dalpiaz
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  6. B. Feragalli
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Correspondence to R. Polverosi.

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Polverosi, R., Guarise, A., Balestro, E. et al. High-resolution CT of nontuberculous mycobacteria pulmonary infection in immunocompetent, non-HIV-positive patients. Radiol med 115, 191–204 (2010). https://doi.org/10.1007/s11547-009-0479-2

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  • DOI: https://doi.org/10.1007/s11547-009-0479-2

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