Nontuberculous Mycobacterial (NTM) Disease in Immunocompetent Patients: Expanding Image Findings on Chest CT

Hyo Hyun Shin; Hyun Ju Seon; Mok Hee Kim; Song Choi; Sang Gook Song; Sang Soo Shin; Yun-Hyeon Kim; Jin Gyoon Park

doi:10.3348/jksr.2010.63.2.137

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Shin, Seon, Kim, Choi, Song, Shin, Kim, and Park: Nontuberculous Mycobacterial (NTM) Disease in Immunocompetent Patients: Expanding Image Findings on Chest CT

Chest Radiology

Original Article

Journal of the Korean Society of Radiology 2010; 63(2): 137-144.

Published online: 31 August 2010

DOI: https://doi.org/10.3348/jksr.2010.63.2.137

Nontuberculous Mycobacterial (NTM) Disease in Immunocompetent Patients: Expanding Image Findings on Chest CT

Hyo Hyun Shin, M.D., Hyun Ju Seon, M.D., Mok Hee Kim, M.D., Song Choi, M.D., Sang Gook Song, M.D., Sang Soo Shin, M.D., Yun-Hyeon Kim, M.D., Jin Gyoon Park, M.D.

Department of Radiology, Chonnam National University, Medical School, Chonnam National University Hospital, Korea.

Address reprint requests to : Hyun Ju Seon, M.D., Department of Radiology, Chonnam National University Hospital 671, Jebongno, Dong-gu, Gwangju 501-757, Korea. Tel. 82-62-220-5746, Fax. 82-62-226-4380, sunaura@hanmail.net

Received 2 February 2010 Accepted 15 March 2010

Abstract

Purpose

The aim of this study was to evaluate the chest CT features of nontuberculous mycobacterial (NTM) disease regardless of the specific organisms.

Materials and Methods

This study included 74 consecutive patients (35 men, 39 women; mean age, 63 years; age range, 25-89 years) who were diagnosed with NTM disease according to the American Thoracic Society Guidelines (1997 and 2007) between January 2005 and July 2007. Chest CT images were randomly reviewed by two radiologists with consensus.

Results

The most common organism associated with NTM disease is M. avium-intracellulare complex (87.8%), followed by M. abscessus, M. kansasii, and M. chelonae. The most common chest CT finding was a nodular bronchiectatic lesion (n = 35, 46.7%), followed by a cavitary lesion of the upper lobe (n = 21, 28.0%), combined lesions of two prior subtypes (n = 6, 8.0%), consolidative lesion (s) (n = 5, 6.7%), a bronchogenic spreading pulmonary tuberculosis-like lesion (n = 5, 6.7%), a cavitary mass lesion with small satellite nodules (n = 2, 2.7%), and a miliary nodular lesion (n = 1, 1.3%). More than 5 segments were involved in 60 cases (81.1%).

Conclusion

The nodular bronchiectatic lesion or cavitary lesion of upper lobe presents with multi-segmental involvement and the occurrence of combined consolidation is indicative of NTM disease.

Keywords: Tomography, X-Ray Computed, Mycobacteria, Atypical, Lung Diseases, Immunocompetence

Figures and Tables

Fig. 1

A 68-year-old woman with hemoptysis. Cultures from bronchoalveolar lavage fluid showed Mycobacterium avium-intracellulare complex.

A, B. axial CT images at the level of mid-thorax show multiple tubular bronchiectasis with multiple centrilobular nodules and branching linear structures (white arrows) in both lungs. These findings are typical findings of nodular bronchiectatic form of pulmonary NTM disease. Also there are peribronchial consolidations with mild volume loss (black arrows) in right middle lobe and inferior lingular segment of left upper lobe.

Fig. 2

A 72-year-old man with chest pain. Cultures from sputum showed Mycobacterium avium-intracellulare complex.

A, B (lung window setting) and C, D (mediastinal window setting), axial continuous CT images at levels of upper thorax show cavitary consolidations (white arrows) with perilesional fibrocicatrization in left upper lobe. These findings are typical findings of upper lobe cavitary form of pulmonary NTM disease. Also old inflammatory lesions (black arrows) are seen in right upper lobe.

Fig. 3

A 34-year-old woman without any respiratory symptoms. Cultures from bronchoalveolar lavage showed Mycobacterium avium-intracellulare complex.

A, B. axial CT images at the level of mid-thorax show only a focal nodular consolidation (white arrows) in lingular segment of left upper lobe.

Fig. 4

A 77-year-old woman with cough and sputum. Cultures from sputum showed Mycobacterium avium-intracellulare complex.

A, B. axial CT images at the level of mid-to-lower thorax show multiple air-space nodules and branching linear structures (white arrows) in both lungs with a cavitary nodule (black arrow) in right lower lobe.

Fig. 5

A 44-year-old man with productive cough and hemoptysis. Cultures from sputum showed Mycobacterium avium-intracellulare complex.

A, B. axial CT images at the level of upper thorax show a 3.2 cm cavitary mass (arrows) containing stippled calcific foci in left apical lung.

C. axial CT image, obtained at more cranial level than A, B. shows multiple satellite nodules (arrowhead) in surrounding lung parenchyma

Fig. 6

59-year-old man with dyspnea and hemoptysis. Cultures from sputum showed Mycobacterium kansasii. Axial CT image at the level of lower thorax shows multiple cystic bronchiectasis with bronchial wall thickening, mucoid impactions and air-fluid levels (arrows) in both lungs.

Table 1

Clinical Findings in the Patients with Nontuberculous Mycobacterial Disease (n=74)

Note.─ ^†: chronic obstructive pulmonary disease,

^‡: sputum smear results that were positive for acid fast bacilli stain

Table 2

Major Chest CT Features of Nontuberculous Mycobacterial Disease According to the Each Nontuberculous Mycobaterium

Note.─ ^†: Mycobacterium avium-intracellulare complex, ^‡: Tuberculosis, ^*: Cystic bronchiectasis

^**: Total number is 75 due to the dual isolation of nontuberculous mycobacterium in one patient (MAC and M. Abscessus)

Table 3

Ancillary Chest CT Features of Nontuberculous Mycobacterial Disease

Note.─ ^†: Mycobacterium avium-intracellulare complex

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