CT findings of fireworks sign in active pulmonary tuberculosis / 中华放射学杂志

ABSTRACT

Objective To analyze the fireworks signs of active pulmonary tuberculosis on CT, improve the understanding of CT findings of active pulmonary tuberculosis, and provide imaging basis for clinical treatment. Methods From January 2009 to December 2015, 26 patients (20 males, 6 females;age 16-72(39 ± 15) years old) with fireworks signs on CT were included, all patients had active pulmonary tuberculosis confirmed by sputum smear, bronchoalveolar lavage, biopsy or surgical specimen. A retrospective analysis of patient′s CT image data including the position, number, pattern of fireworks signs and other associated abnormalities were performed and the imaging features were summarized, pathological correlation with CT images was performed in patients with surgical or biopsy results. Results The fireworks signs on CT could be divided into three typeshalo pattern, reversed halo pattern and homogenous pattern, which were 2, 7, 23 cases respectively in this study. Fireworks signs in 9 cases were located in unilateral lung field and 17 cases in bilateral lung field. Distribution of lesions was common bilaterally, mainly in the apical, posterior (apicoposterior) segments of the upper lobes and the superior segments of the lower lobes. Fireworks sign presented as a solitary lesion in 7 cases, 2 lesions in 3 cases, more than 3 lesions in 16 cases. Other pulmonary abnormalities included cavities, consolidation, tree-in-bud sign, pleural effusion, pleural thickening and mediastinal lymphadenopathy. Pathologically, fireworks sign corresponded to caseous granulomas in the bronchioles and alveoli. Conclusion Fireworks sign is one of CT signs of active pulmonary tuberculosis, which formed by the bronchial dissemination of tuberculosis on CT and the granulomas in bronchioles and alveoli on pathology.