A CT-based comparative study of radiological patterns of pulmonary tuberculosis in patients with type 2 diabetes versus non-diabetics

• Published in: International journal of diabetes in developing countries Vol. 37; no. 2; pp. 206 - 214
• Main Authors: Dwivedi, Amit Nandan Dhar, Tripathi, Kamlakar, Mishra, Jai Krishna, Upadhyay, Ashish, Singh, Rajeev, Shukla, Ram Chandra
• Format: Journal Article
• Language: English
• Published: New Delhi Springer India 01.06.2017; Springer Nature B.V
• Subjects: Adolescents; Cavitation; Contrast media; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Epidemics; Family Medicine; General Practice; Health Administration; Lymphadenopathy; Medicine; Medicine & Public Health; Nodules; Original Article; Pleural effusion; Public health; Tuberculosis; Diabetic complications; Epidemiology; Computerized tomography; Pulmonary tuberculosis
• ISSN: 0973-3930; 1998-3832
• DOI: 10.1007/s13410-016-0533-2

The diabetic epidemic, although apparent across the world, has been most pronounced in non-European populations. Type II diabetes in children, teenagers and adolescents is a serious aspect to the epidemic and is an emerging public health problem. Patients with diabetes mellitus are also at higher risk of tuberculosis. We aim to study the differences in radiological pattern of pulmonary tuberculosis using high-resolution and contrast-enhanced CT scans in patients with concomitant diabetes mellitus as compared to those without diabetes and study the atypical radiological manifestations of pulmonary tuberculosis in diabetics. All the patients included in this study were scanned using VCT LIGHT SPEED 64-slice multidetector CT scanner of GE. A non-contrast scan was acquired followed by a contrast-enhanced scan. Brief history of patients was taken with regard to possibility of adverse reaction to the iodinated contrast media. Features like cavity, consolidation, centrilobular nodules, tree-in-bud pattern, pleural effusion and lymphadenopathy were noted. The patients of tuberculosis (50) with diabetes tended to be older than the patients without diabetes (50). No significant difference was seen in the frequency of upper lobe involvement between the two groups. Consolidation in lower lobes is more common in patients with diabetes. Cavitary lesions are also more common in lower lobes in patients with diabetes. No significant difference was seen in terms of bilateral involvement between the two groups. No significant difference was also seen in terms of pleural effusion and lymphadenopathy. Patients of tuberculosis with diabetes showed a significantly higher prevalence of endobronchial spread (51%) compared to non-diabetics (30%). Diabetes mellitus alters the radiological appearance of pulmonary tuberculosis. In a patient with tuberculosis, a radiological appearance of lower lobe consolidation and lower lobe cavitation should alert the clinician towards the presence of concomitant diabetes mellitus.