Comparison of roentgenographic manifestations of active pulmonary tuberculosis between migrant and non-migrant populations in the Hunter Region

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Introduction:Active pulmonary tuberculosis in Australia is considered more common in migrants and the immunocompromised, but little data exist on how it manifests in non-migrants. This study identified the radiographic findings of active pulmonary tuberculosis in the Hunter Region, NSW, Australia, and determined whether this manifests differently in non-migrant and migrant populations.Methods:We retrospectively analysed 64 patients over 8 years from the Hunter Region, who had positive Mycobacterium tuberculosis cultures and contemporaneous thoracic imaging. Recorded data included age, gender, country of origin and chest radiographic findings, the latter categorised into apical fibrocavitatory disease, mixed apical fibrocavitation and consolidation, consolidation, lymphadenopathy, pleural effusions, tree-in-bud, empyema and miliary nodules.Results:Sixty-four patients (men = 37, women = 27) had available thoracic imaging, of which 34 were Australian born. There was no statistically significant difference in the age between Australian-born and migrants (49.1 years (95% confidence interval, CI 42.8–55.5) vs 48.2 years (95% CI 41.1–55.3), P = 0.71). The most common radiographic manifestations were purely apical fibrocavitatory lesions (22%), mixed apical fibrocavitation and consolidation (6%) and purely consolidation (27%). Migrants were more likely to have consolidation (40%), while Australian-born individuals were more likely to have apical fibrocavitatory lesions (26%). Australian-born individuals were slightly more likely to have a normal chest radiograph (18% vs 10%).Conclusion:There are radiographic differences between Australian-born and migrant populations with active pulmonary tuberculosis. Migrants are more likely to present with consolidation, and Australian-born with fibrocavitatory lesions. A normal chest radiograph does not exclude active tuberculosis, and while thoracic computed tomography may be useful to detect tree-in-bud opacities, neither should not detract from commencing treatment of a positive culture for tuberculosis.

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