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Q J Med 1989; 71: 529-535
© 1989 Association of Physicians

research-article

The Radiograpy, Haematology and Biochemistry of Pulmonary Tuberculosis in the Aged

CHARLES D. W. MORRIS

Department of Medicine, Frere Hospital East London, South Africa

Accepted for publication 23 January 1989.

SUMMARY

Ninet-three elderly patients with pulmonary tuberculosis wer surveyed prospectively to determine the extent and severity of radiological, haematological and biochemical abnormalities.

Radiological features of inflammator changes were present in all patients; 7 per cent of these were purely apical, 48 per cent were in mid and basal zones and in 46 per cent there was a mixed picture. Cavities were seen in 33 per cent of radiographs; half of these occured in the apical and half in the mid and basal zones. A pleural reaction was present in 46 per cent of cases. Hilar gland enlargement was not seen. A pleural reaction was present in 46 per cent of cases. Hilar gland enlargement was not seen. Thus radiographs ‘atpical’ for pulmonary tuberculosis were usual with the major changes being basal and peripheral. Haematological abnormalities were normochromic normoctic anaemia (66 per cent), neutrophilia (69 per cent), thromoboctosis (33 per cent), rapid erthrocte sedimentation rate (90 per cent), and lmphoctopenia and monoctosis in 22 and 28 per cent respectivel. Biochemical abnormalities were hponatraemia (60 per cent), hypokalaemia (42 per cent), hypoalbuminaemia (83 per cent), and (before treatmenta) elevation of bilirubin (20 per cent), alkaline phosphatase (62 per cent), aspartic transaminase (77 per cent) and lactic dehdrogenase (74 per cent). The abnormal liver function tests may reflect unsuspected extrapulmonar disease.

Radiologically mild opacification occurring frequently in the lower zones and associated with a pleural reaction in half of cases is compatible with tuberculosis. The unexplained presence of an of these haematological and biochemical abnormalities should raise suspicion of the disease.


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