• Users Online: 446
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
Year : 2021  |  Volume : 6  |  Issue : 2  |  Page : 168-172

Patterns of request and radiographic findings in patients with pulmonary tuberculosis in a secondary healthcare center in Borno State, Nigeria

1 Department of Radiology and Imaging, Maryam Abatcha Women and Children Hospital, Maiduguri, Borno State, Nigeria
2 Department of Radiology, Federal Neuro Psychiatric Hospital, Maiduguri, Borno State, Nigeria
3 Department of Medical Radiography, Faculty of Allied Health Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria

Date of Submission27-Nov-2020
Date of Decision03-May-2021
Date of Acceptance03-May-2021
Date of Web Publication08-Jan-2022

Correspondence Address:
Alhaji Modu Ali
Department of Radiology, Federal Neuro Psychiatric Hospital, P.M.B 1322, Maiduguri, Borno State
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/bjhs.bjhs_126_20

Rights and Permissions

BACKGROUND AND AIM: Pulmonary tuberculosis (PTB) is a major public health problem globally with relatively high morbidity and mortality rates. Chest radiography plays a key role in describing the patterns of appearances which help in predicting treatment progress. In this study, we evaluated the patterns of radiographic findings among patients diagnosed with PTB.
MATERIALS AND METHODS: This was a retrospective study of clinical and chest radiographic features of PTB in 105 patients. All the radiographs were reported by a consultant radiologist. The age, gender, clinical presentation, nature and location of the lung changes, and diagnosis were recorded. Descriptive statistics were employed in analysing mean ± standard deviation, percentages, and frequencies. Data were analyzed using the SPSS software version 22.0.
RESULTS: The male-to-female ratio was 3:2 with 58.1% (n = 61) male and 41.9% (n = 44) female. The average age of the patients was 36.29 ± 15.95 years with 21–30 years age group most affected. Fibrocavitatory changes alone were the most common finding and the majority of the lung changes involved the entire both lungs.
CONCLUSION: Fibrocavitatory changes and involvement of the entire both lungs were found to be the common radiographic findings of patients diagnosed with PTB. Age group 21–30 years was most commonly affected.

Keywords: Chest radiography, Nigeria, patterns, pulmonary tuberculosis

How to cite this article:
Abba-Sulum HK, Ali AM, Njitti MM, Hassan JM, Abubakar A, Shettima A. Patterns of request and radiographic findings in patients with pulmonary tuberculosis in a secondary healthcare center in Borno State, Nigeria. BLDE Univ J Health Sci 2021;6:168-72

How to cite this URL:
Abba-Sulum HK, Ali AM, Njitti MM, Hassan JM, Abubakar A, Shettima A. Patterns of request and radiographic findings in patients with pulmonary tuberculosis in a secondary healthcare center in Borno State, Nigeria. BLDE Univ J Health Sci [serial online] 2021 [cited 2022 Jul 6];6:168-72. Available from: https://www.bldeujournalhs.in/text.asp?2021/6/2/168/335323

Pulmonary tuberculosis (PTB) is a contagious bacterial disease which mostly affects the lungs but may spread to other organs in the body.[1],[2],[3] TB is caused by the bacteria called tubercle bacillus or Mycobacterium tuberculosis.[4] The disease spread either by droplet infection from an individual with active TB, or in dust contaminated by infected sputum.[5] PTB remains the most common global infectious disease which is characterized by high mortality and morbidity rates, especially in the developing nations.[6] The World Health Organization referred TB as the single most important deadly infectious disease, with a incidence rate of 10.0 million and an annual mortality rate of 1.7 million.[7] TB is a major public health problem in Nigeria and it ranks 7th among the 30 high TB burden countries worldwide and 2nd in Africa, accounting for 4% of the estimated incidence cases globally.[8] It has been estimated that about 460,000 cases of TB occur in Nigeria every year with incidence and mortality rates of 219/100,000 and 39/100,000 population, respectively.[8]

PTB can be symptomatic or asymptomatic (latent) form.[9] Latent TB infection (LTBI) is defined as a state of persistent infection without clinical features of active disease.[10],[11] When the clinical feature of the disease is present, the term TB is used without a further prerequisite is used to designate the disease.[11] Based on this description, both TB and LTBI may be considered different phases in a continual pathological process, and both conditions are usually distinguished on the basis of the presence (TB) or absence (LTBI) of clinical, microbiological (direct microscopy or culture), and radiographic findings.[10] Chest radiography is currently used for screening, diagnosis and management of patients on anti-TB treatment.[12] Despite its low sensitivity and a high interobserver variability, it remains a valuable adjunct to clinical and microbiological diagnosis.[13] Several quantitative chest radiographic scoring systems have been developed over the years and some have shown the potential to reduce the interobserver variability and increase the sensitivity of the chest radiograph in TB cases especially with digital radiographic systems.[14],[15]

The radiographic feature of PTB varies with the stage of the infection, radiographic technique used and other associated conditions. However, the typical feature chest X-ray include focal upper lobe opacities, diffuse opacities, reticulonodular opacities, cavities, nodules, consolidation, unilateral pleural effusion, miliary pattern, mediastinal, and hilar lymphadenopathy.[16] Primary PTB appears homogeneous and mimics community-acquired pneumonia. Any lobe may be involved; size varies from subsegmental to an entire lobe. Compared with community-acquired pneumonia, primary PTB may exhibit nodal enlargement, usually ipsilateral, hilar, and/or mediastinal.[17] In fact, lymphadenopathy is the most common manifestation of primary TB in children and occurs with or without pneumonia.[17] Postprimary PTB radiographically, present in 95% of patients the initial lesions are poorly marginated, nodular and linear opacities which arise in the apicoposterior segments of an upper lobe and/or the superior segment of a lower lobe.[17] Cavitation, fibrosis, pleural effusion, and calcification are also forms of manifestation of postprimary TB. Military TB now occurs more commonly as a manifestation of postprimary than of primary disease.[17]

Among the diagnostic tools traditionally used for the diagnosis of PTB, the chest radiography plays a pivotal role, mainly because it is widely available, accessible, and cheap within the public health system, even in local areas. Therefore, we designed this study to determine the patterns of clinical indication/request and radiographic findings in patients with PTB in the study locality which will go a long way in the proper diagnosis of the patients.

  Materials and Methods Top

Chest radiographs of (105) patients referred to the radiology department of the Maryam Abatcha women and children hospital, Jere, Nigeria from May to September 2019 with a radiographic features of PTB coupled with clinical information were retrospectively reviewed. All the radiographs were interpreted by a consultant radiologist. Data were retrieved from the radiological information systems of the hospital. All the radiographic examinations were carried out on a Triup stationary digital X-ray machine (Model № TR50KW-WT, Nanjing, China).

Data were collected using data capture sheet with age, clinical presentation, nature, and location of the lungs changes as variables. Descriptive statistics (mean ± standard deviation, range, frequency, and percentage) were used to analyze the data, and statistical analysis was performed using the Statistical Package for the Social Sciences software version 22.0 (IBM, Armonk, NY, USA).

  Results Top

A total of 105 clinical and radiographic records of patients with features of PTB were evaluated for the study. The study comprised 61 (58.1%) males and 44 (41.9%) females. Their ages ranged from the ages 6 to 75 years, with mean age of 36.29 ± 15.95 years. The most affected age group was 21–30 years (32.4%) as shown in [Table 1].
Table 1: Age distribution of patients

Click here to view

The most common clinical indications based on the request form was the querying (?) chest infection (26.7%) followed by querying (?) PTB (13.3%) while acute respiratory infection, peripartum cardiomyopathy, immunosuppression, cough + weight loss + poor appetite + headache, and cough + fever + headache + hemoptysis and cough + weight loss + chest pain + loss of appetite had the least occurrences (1% each) as shown in [Table 2].
Table 2: Clinical indications based on request forms

Click here to view

[Table 3] shows the distribution of the chest radiographic pattern of the PTB. The most common feature was the fibrocavitatory changes alone which was found in 39 (37.1%) cases as seen on [Figure 1], followed by nodular opacities with cystic background changes which had 10 (9.5%) cases as in [Figure 2] while pinhead opacities, consolidation + nodular opacities, fibrocavitatory changes + pleural effusion, fibrocavitatory changes + pleural calcification, and reticolu-nodular opacities + cystic changes + pleura effusion + calcification had the least occurrence (1% each).
Table 3: Distribution of the chest radiographic features of pulmonary tuberculosis

Click here to view
Figure 1: A posteroanterior chest radiograph showing fibro-cavitatory changes in a 50-year-old man presented with cough fever and weight loss

Click here to view
Figure 2: An anteroposterior AP chest radiograph showing widespread nodular opacities with cystic changes involving both lungs in a 16-year-old female presented with chronic cough and progressive weight loss

Click here to view

[Table 4] shows the pattern of changes in relation to part of the lungs affected. Both lungs were affected in the majority of the cases (41.9%) while both mid zones, right mid zone, left mid and upper zones and; both upper zones and left mid zones were affected in only 1 (1%) case each.
Table 4: Patterns of changes in relations to part of the lungs affected

Click here to view

  Discussion Top

PTB is one of the top ten causes of death globally. About 1/4 of the world's population had latent PTB.[18] Chest radiography is the primary radiographic examination for suspected or proven PTB cases.

The result of this study showed that the male-to-female ratio was 3:2. This finding is in agreement with those of Akhigbe et al.,[19] van Cleeff et al.[20] and Rao[21] who reported a male-to-female ratios of 2.6:1, 3:2, and 2:1, respectively. This could be attributable biological, environmental and lifestyle factors. On the contrary, Umar et al.[22] reported a male-–to-female ratio of 5:7.

The average age of the affected patient in this study was 36.29 ± 15.95 years with 21–30 years was the most affected age group (32.4%). This finding is in agreement with those of Desalu et al.[23] and Peters et al.[24] who reported a mean age of 35.1 ± 8.4 years and 34.60 ± 1.2 years in Yola and Calabar, Nigeria, respectively. On the contrary, Akhigbe et al.[9] and Umar et al.[22] in Lagos and Kano, Nigeria, respectively, reported in their study a mean age of 32.16 ± 8.72 and 31.62 ± 16.93 years; with 26–38 and <30 years, respectively, as predominantly affected age group. This variation could be attributable to the differences in geographical location, environmental factors, nature of the study adopted, etc.,

The clinical presentations of PTB are nonspecific, and there is no clinical sign or symptom that is exclusive to the disease. Chronic cough (>3 weeks) is a sentinel of PTB.[25] One study found that symptom in 96% of a group of patients with PTB.[26] These findings are similar to that found in the present study.

In this study, fibrocavitary changes alone was the most common lungs changes (37.1%), followed by nodular opacities with cystic background changes (9.5%) and both lungs were affected in most cases (41.9%). This finding is in agreement with that of Besen et al.[27] who reported highest occurrence of cavitations among HIV negative patients. On the contrary, Akhigbe et al.[9] and Akhigbe et al.[19] reported consolidation as the most common findings, followed by fibrocavitation. The predominance of the cavitations over consolidation can be explained by the large proportion of nonimmunocompromised individuals in our study sample. The predominance of cavitation might also be due to the fact that the disease was diagnosed lately.[25],[28]

In the current study, the abnormal chest radiographic patterns are distributed around six different anatomical regions of the lungs. The six identified anatomic regions were: left upper zone, left lower zone, right upper zone, right lower zone, and right middle zone. Entire both lungs were affected in the majority of the cases (41.9%) while both mid zones, right mid zone, left mid and upper zones and; both upper zones and left mid zones were affected in only 1 (1%) case each. This finding is in agreement with that of Wilcke et al.[29] who found that the entire both lungs were affected in most cases (55%). On the contrary, Akhigbe et al.[19] who found that the left upper zone is affected in the majority of the cases (37.56%) while entire both lungs were affected in only 7.18% of the cases. Furthermore, Lachi and Nakayama[30] reported that the entire right lung was affected in most cases in their study. This discrepancy in our findings may be attributed to the nature of the subjects studied, study design and variation in geographical location. Our study had the following limitations: Radiographic findings were not compared with the results of either microbiological or advance imaging modality such as computed tomography, patient's HIV status was unknown and the anti TB treatment status of the patients was also unknown.

  Conclusion Top

Fibrocavitatory changes and involvement of the entire both lungs were found to be the common radiographic findings of patients diagnosed with PTB in this study which is a radiographic manifestation of postprimary TB. Male preponderance was noted. The most affected age group of 21–30 years.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Sauders E. Robbins Basic Pathology. 8th ed. London: Cambridge Press; 2007. p. 516-20.  Back to cited text no. 1
Iseman MD. A clinician's Guide to Tuberculosis. Philadelphia: Lippincott Williams and Wilkins; 2000.  Back to cited text no. 2
World Health Organization. Global Tuberculosis Control 2011- Epidemiology Strategy Financing. Geneva: World Health Organization; 2011.  Back to cited text no. 3
Scanlon VC, Sanders T. Essentials of Anatomy and Physiology. 5th ed. Philadelphia: EA Davis Company; 2007.  Back to cited text no. 4
Waugh A, Grant A. Ross and Wilson Anatomy and Physiology. 11th ed. Philadelphia: Churchill Livingstone Elsevier; 2010.  Back to cited text no. 5
Gordin FM, Masur H. Current approaches to tuberculosis in the United States. JAMA 2012;308:283-9.  Back to cited text no. 6
World Health Organization. Global Tuberculosis Report 2019. Geneva: World Health Organization; 2019.  Back to cited text no. 7
Federal Ministry of Health Nigeria. National Tuberculosis Catastrophic Cost Survey: Report of the National Survey to Determine the Proportion of TB Patients and their Households Experiencing Catastrophic Cost due to TB. Abuja, Nigeria: Federal Ministry of Health Nigeria; 2017.  Back to cited text no. 8
Akhigbe RO, Ugwu AC, Ogolodom MP, Ihua N, Maduka BU, Jayeoba BI. Evaluation of chest radiographic patterns and its relationship with haematological parameters in patients with pulmonary tuberculosis in Lagos Metropolis, Nigeria. Health Sci J 2019;13:628.  Back to cited text no. 9
Lew WJ, Jung YJ, Song JW, Jang YM, Kim HJ, Oh YM, et al. Combined use of QuantiFERON-TB Gold assay and chest computed tomography in a tuberculosis outbreak. Int J Tuberc Lung Dis 2009;13:633-9.  Back to cited text no. 10
Mack U, Migliori GB, Sester M, Rieder HL, Ehlers S, Goletti D, et al. LTBI: Latent tuberculosis infection or lasting immune responses to M. tuberculosis? A TBNET consensus statement. Eur Respir J 2009;33:956-73.  Back to cited text no. 11
Rubin SA. Tuberculosis. Captain of all these men of death. Radiol Clin North Am 1995;33:619-39.  Back to cited text no. 12
Te Riele JB, Buser V, Calligaro G, Esmail A, Theron G, Lesosky M, et al. Relationship between chest radiographic characteristics, sputum bacterial load, and treatment outcomes in patients with extensively drug-resistant tuberculosis. Int J Infect Dis 2019;79:65-71.  Back to cited text no. 13
Pinto LM, Dheda K, Theron G, Allwood B, Calligaro G, van Zyl-Smit R, et al. Development of a simple reliable radiographic scoring system to aid the diagnosis of pulmonary tuberculosis. PLoS One 2013;8:e54235.  Back to cited text no. 14
Ralph AP, Ardian M, Wiguna A, Maguire GP, Becker NG, Drogumuller G, et al. A simple, valid, numerical score for grading chest x-ray severity in adult smear-positive pulmonary tuberculosis. Thora×2010;65:863-9.  Back to cited text no. 15
Giacomelli IL, Marchiori E, Percia M, Hochleggen B. Chest x-ray and chest CT findings in patients diagnosed with pulmonary tuberclosis following solid organ transplant: A systematic review. J Bras Pneumol 2018;44:161-6.  Back to cited text no. 16
Adam A, Dixon AK, Grainger RG, Allison DJ, editors. Grainger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging. 5th ed. Philadelphia: Elsevier Churchill Livingstone; 2008.  Back to cited text no. 17
World Health Organization. Tuberclosis; 2008. Available from: https://www.who.int>...>Detail. [Last accessed on 2020 Jul 17].  Back to cited text no. 18
Akhigbe RO, Ugwu AC, Ogolodom MP, Maduka BU, Jayeoba BI. Abnormal chest radiographic patterns in patients with pulmonary tuberculosis in Lagos State, Nigeria: A single centre study. Intern J Med Hea Res 2019;5:36-40.  Back to cited text no. 19
van Cleeff MR, Kivihya-Ndugga LE, Meme H, Odhiambo JA, Klatser PR. The role and performance of chest X-ray for the diagnosis of tuberculosis: A cost-effectiveness analysis in Nairobi, Kenya. BMC Infect Dis 2005;5:111.  Back to cited text no. 20
Rao S. Tuberculosis and patient's gender: Analysis and its implications in tuberculosis control. Lung India 2009;26:46-7.  Back to cited text no. 21
[PUBMED]  [Full text]  
Umar MS, Daniel SV, Suwaid MA, Luntsi G, Yusuf J, Zira JD, et al. Chest radiographic findings of pulmonary tuberculosis in human immunodeficiency virus-seropositive patients in a teaching hospital in Kano Northwest, Nigeria. West Afr J Radiol 2020;27:27-32.  Back to cited text no. 22
  [Full text]  
Desalu OO, Olokoba A, Danfulani M, Gambo Z, Salawu F, Danburam A, et al. Impact of immunosuppression on radiographic features of HIV related pulmonary tuberculosis among Nigerians. Turk Toraks Derg 2009;10:112-6.  Back to cited text no. 23
Peters EJ, Essien OE, Immananagha KK, Inah GA, Philip-Ephraim EE, Agbulu RE. CD4 count levels and pattern of respiratory complications in HIV seropositive patients in Calabar, Nigeria. Niger J Physiol Sci 2007;22:93-7.  Back to cited text no. 24
Domínguez Del Valle F, Fernández B, Pérez de Las Casas M, Marín B, Bermejo C. Clinical manifestations and radiology of thoracic tuberculosis. An Sist Sanit Navar 2007;30 Suppl 2:33-48.  Back to cited text no. 25
Job JR, Prado PE, Vranjac S, Duarte PC. Comparison of epidemiological data on pulmonary tuberculosis in Sorocaba, Säo Paulo, Brazil, (1986-1996). Rev Saude Publica 1998;32:596-7.  Back to cited text no. 26
Besen A, Staub GS, Maurici RS. Clinical, radiological, and laboratory characteristics in pulmonary tuberculosis patients: Comparative study of HIVpositive and HIV-negative inpatients at a referral hospital. J Bras Pneumol 2011;37:768-75.  Back to cited text no. 27
Burrill J, Williams CJ, Bain G, Conder G, Hine AL, Misra RR. Tuberculosis: A radiologic review. Radiographics 2007;27:1255-73.  Back to cited text no. 28
Wilcke JT, Askgaard DS, Nybo Jensen B, Dbssing M. Radiographic spectrum of adult pulmonary tuberculosis in a developed country. Respir Med 1998;92:493-7.  Back to cited text no. 29
Lachi T, Nakayama M. Radiological Findings of Pulmonary tuberculosis in indigenous patients in Dourados, MS, Brazil. Radiol Bras 2015;48:275-81.  Back to cited text no. 30


  [Figure 1], [Figure 2]

  [Table 1], [Table 2], [Table 3], [Table 4]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Materials and Me...
Article Figures
Article Tables

 Article Access Statistics
    PDF Downloaded46    
    Comments [Add]    

Recommend this journal