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BACKGROUND: Little is known about culture-negative subclinical pulmonary tuberculosis (TB), and its diagnosis remains challenging. Therefore, this study aimed to identify the characteristics and the extent of disease associated with culture-negative subclinical pulmonary TB. METHODS: This retrospective cohort study was conducted on immunocompetent individuals with subclinical pulmonary TB at a university hospital in Thailand from January 2014 to December 2019. Subclinical pulmonary TB was diagnosed based on the presence of radiographic abnormalities consistent with TB in the absence of TB symptoms. All subjects demonstrated significant improvement or resolution of radiographic abnormalities following the completion of treatment. At least two negative sputum cultures were needed to fulfill the definition of culture-negative pulmonary TB. Data were analyzed using univariate and multiple logistic regression analyses to determine the characteristics of those with culture-negative subclinical pulmonary TB compared to culture-positive ones. RESULTS: Out of the 106 individuals identified with subclinical pulmonary TB, 84 met the criteria for inclusion in the analysis. The study found lower radiographic extent and increasing age were key attributes of culture-negative subclinical pulmonary TB. The odds ratios (95% confidence interval) were 7.18 (1.76 to 29.35) and 1.07 (1.01 to 1.13), respectively. They tend to have lower rates of bilateral involvement in both chest x-ray (8.5% vs. 32.0%, p=0.006) and computed tomography (15.4% vs. 42.9%, p=0.035). However, no other specific radiographic findings were identified. CONCLUSIONS: People with culture-negative subclinical pulmonary TB were likely to have less radiographic -severity, reflecting early disease. Nevertheless, no radiographic patterns, except for unilaterality, were related to culture-negative subclinical pulmonary TB.
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Background: Whole abdominal ultrasound sometimes shows no significant findings in the lower abdomen, especially in patients without indications related to this area. Those patients have to spend a lot of time waiting for their test and refrain from urination in order to complete whole abdominal examinations but gain no additional benefit. Objective: To analyze the results of lower abdominal ultrasound in patients who were sent for ultrasound of the whole abdomen; to correlate the results with indications for requesting ultrasound based on diagnosis or clinical findings in the lower abdomen; and examine their associations with further management of the patients who had positive findings. Material and Method: A retrospective analysis was performed of 440 whole abdominal ultrasound studies at the Department of Radiology, Rajavithi Hospital from January 2011 to December 2012. Indications on the request forms and reports were reviewed, focusing on lower abdominal findings. Data were recorded for indications, results, and post-examination management. Positive indications for lower abdominal study were taken as diagnoses of diseases related to the lower abdomen, symptoms and signs in the lower abdomen, and findings in the lower abdomen. Results: A total of 440 cases were analyzed, consisting of 268 females and 172 males with mean age 56.44 years. Negative indications were recorded for 74.8% and the most common indication was checkup (37.0%). Positive results were seen in 22.3% of cases, most of which were benign conditions (78.6%). In the groups of positive and negative indications, 35.1% and 17.9% had positive results, and 15.3% and 1.2% respectively were diagnosed as having (or probably having) malignancy. Over 90.0% of the positive results in the negative indication group were benign and 62.2% had no further post-examination management, consultation, or related investigation. Conclusion: Most of the results of lower abdominal ultrasound in the patients sent for whole abdominal ultrasound were negative, and the majority of the positive findings were benign conditions requiring no further management. More positive results, especially findings suggestive or suspicious of cancers, were seen in cases with positive clinical data. Routine use of whole abdominal ultrasound does not appear to be very helpful, especially in patients who have no symptoms in the lower abdomen.