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Atypical radiological images of pulmonary tuberculosis in 192 diabetic patients: a comparative study

Authors: Pérez-Guzmán, C.1; Torres-Cruz, A.2; Villarreal-Velarde, H.3; Salazar-Lezama M., A.2; Vargas M., H.4

Source: The International Journal of Tuberculosis and Lung Disease, Volume 5, Number 5, May 2001 , pp. 455-461(7)

Publisher: International Union Against Tuberculosis and Lung Disease

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SETTING: Comparative studies of pulmonary tuberculosis images in diabetics have yielded conflicting results.

OBJECTIVE: To assess radiological images of pulmonary tuberculosis in a large population of diabetic patients

DESIGN: Radiographs from in-patients admitted with pulmonary tuberculosis and diabetes (TBDM group, n = 192) were reviewed and compared with a control group of patients with pulmonary tuberculosis alone (TB group, n = 130).

RESULTS: Both groups had a similar evolution time of tuberculosis (∼2 years). Statistical differences were observed as follows: TBDM patients were older (51.3 ± 0.9 vs. TB group 44.9 ± 1.8 years, mean ± SEM), and had a decreased frequency of upper (17% vs. 56%), and an increased frequency of lower (19% vs. 7%) and upper + lower (64% vs. 36%) lung field lesions. More TBDM patients developed cavitations (82% vs. 59%) more often in the lower lung fields (29% vs. 3%). More multiple cavities were seen in TBDM patients (25% vs. 2%). TBDM group had a lower total leukocyte count (8836.7 ± 219.5 vs. 10013.1 ± 345.2 cells/mm3), mainly due to a lower number of non-lymphocyte cells (6815.8 ± 221.8 vs. 8095.7 ± 321.9 cells/mm3). Multiple logistic regression showed that being a diabetic patient was the most important factor determining lower lung field lesions and cavities.

CONCLUSIONS: This study in a large number of diabetics with pulmonary tuberculosis confirmed that their chest X-ray images significantly depart from the typical presentation. Clinicians must keep this in mind to avoid misdiagnosis.

Keywords: cavitation; chest X-rays; comparative study; diabetes mellitus; pulmonary tuberculosis; radiology; roentgenogram

Document Type: Regular Paper

Affiliations: 1: Instituto Nacional de Enfermedades Respiratorias, Departamento de Neumología, Hospital General, CMN La Raza, Instituto Mexicano del Seguro Social, México DF, México 2: Instituto Nacional de Enfermedades Respiratorias, México DF, México 3: Hospital General ÒDr. Manuel Gea GonzálezÓ, México DF, México 4: Instituto Nacional de Enfermedades Respiratorias, and Hospital de Pediatría, CMN Siglo XXI, Instituto Mexicano del Seguro Social, México DF, México

Publication date: May 1, 2001

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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