Imaging features and diagnosis of lung lesions caused by COVID-19 and active pulmonary tuberculosis co-infection

Abstract

Background. Tuberculosis and COVID-19 co-infection is a major challenge, especially in Moldova with high TB incidence. Overlapping symptoms and imaging findings complicate diagnosis. Computed tomography is essential for detecting and assessing lung lesions in patients with active TB and COVID-19 co-infection. Objective(s). Characteristics of imaging findings and diagnosis of lung lesions caused by coinfection with COVID-19 and active pulmonary tuberculosis to enable timely evaluation and diagnosis. Materials and methods. A review of PubMed and Scopus (2020–2023) examined WHO, ACR, ESR, and RSR guidelines on radiologic diagnosis of COVID-19 and active pulmonary tuberculosis co-infection. Data from 55 cases confirmed by PCR and BAAR tests were analyzed using CT and chest X-rays. The Brixia score was applied to quantify lung lesion severity and monitor progression. Results. Distribution of 55 COVID-19 and tuberculosis co-infection cases in Moldova: center 65.5%, north 27.6%, south 6.9%. Average age 45.82 years, 75.9% men. Diagnosis by PCR for COVID-19 and BAAR test for tuberculosis. Imaging: CT and chest X-rays. Lesions include ground-glass opacities, consolidations, cavities, and adenopathy. CT identified coexisting lesions in 85% of cases. Typical COVID-19 patterns: ground-glass and “crazy paving.” The Brixia score assessed severity and progression, ranging from mild to severe. CT is essential and sensitive for diagnosis and differentiation in COVID-19 and active tuberculosis coinfection. Conclusion(s). The study optimizes early identification of COVID-19 lung lesions in patients with active tuberculosis. CT reveals specific patterns, with bilateral changes, ground-glass opacities, Halo sign, lenticular nodules, and pleural effusion, essential for diagnosis and treatment.