Initial roentgenographic manifestations of pulmonary Mycobacterium tuberculosis, M kansasii, and M intracellularis infections.

The initial radiographic features of 188 patients with pulmonary infections due to Mycobacterium tuberculosis were compared to 184 patients with M kansasii and 100 patients with M intracellularis infections. The patients were all from the University of Texas Health Center at Tyler, all had at least two positive sputum cultures and no other potential pathogen, and none had a past medical history of any type of tuberculosis. The comparison showed that all three organisms have a strong tendency to produce cavitary infiltrates in the posterior portions of the upper lobes. No distinctive or pathognomonic feature could be found. The atypical organisms were more likely to produce thin-walled cavities and far advanced unilateral disease, but both of these patterns also occurred with M tuberculosis. Endobronchial spread and volume loss were common in all three diseases. The only definite difference seems to be the absence of a primary or juvenile form of atypical tuberculosis and a much greater incidence of empyema and postprimary pleural effusions with M tuberculosis. In an individual case, the roentgenographic manifestations of the three diseases are indistinguishable.