Pulmonary tuberculosis: recognising the imaging features – a practical guide for radiographers
Pulmonary tuberculosis (PTB) remains a significant public health challenge, particularly among vulnerable populations, where delayed diagnosis can contribute to ongoing transmission and poorer patient outcomes. Although the UK has a relatively low incidence compared with many other regions worldwide, TB continues to affect communities across the nation. For radiographers working in emergency, inpatient and outpatient settings, awareness of PTB and its varied imaging appearances is essential in supporting a timely diagnosis and management. The clinical presentation of PTB can be subtle, with symptoms frequently overlapping with more common respiratory conditions. Consequently, imaging often provides the first indication that TB should be considered. Chest radiography remains central to the diagnostic pathway, while CT provides increased sensitivity for assessing subtle parenchymal changes, cavitation, lymphadenopathy and disseminated disease.
This article explores the key imaging appearances of PTB, including upper lobe predominance, consolidation, cavitation, lymphadenopathy, pleural involvement, fibrotic changes and miliary disease. Recognising these patterns alongside understanding atypical presentations can help radiographers identify examinations that may require urgent clinical review. Radiographers occupy a unique position within the patient pathway, often being the first healthcare professionals to visualise abnormalities that may suggest TB. Although diagnosis relies on clinical assessment, microbiological confirmation and formal reporting, radiographers play an important role in recognising suspicious findings, communicating concerns and facilitating timely escalation. Maintaining familiarity with both classical and less typical manifestations of PTB enables radiographers to potentially truncate the patient’s journey to a diagnosis. Through vigilance and effective communication, radiographers remain a vital component of supporting TB prevention efforts.
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