Radiology of Nontuberculous Mycobacterium

In this video, we talk about the imaging findings of pulmonary nontuberculous mycobacterium (NTM) infection. We discuss both the nodular bronchiectasis form and the fibrocavitary form of the disease with many examples, and discuss a few things to keep in mind in the differential.

Textbooks I like for chest radiology—
Med students and all residents: Felson’s Principles of Chest Roentgenology

Radiology residents: Thoracic Imaging: Pulmonary and Cardiovascular Radiology

Thoracic radiology fellows: Muller’s Imaging of the Chest: Expert Radiology Series

[tapaskumarsahu]

Loved it. In TB endemic countries like India it's difficult to call it NTM before TB...So ultimately answer by bronchial lavage/sputum test (Microbiology)!!

[romsa]

Thank you very much! How to distinguish a lymph node from a nodulus on CT?

[llquar]

Can empyematic pleural effusions be a sign of any NTM infection?

[drabhib]

Great cases. I have one query in first case, is there minimal pericardial effusion?

[Mood-lqdu]

Thanks for the very educational video as always. I am a radiologist and have three questions. I would be very grateful if you could answer:
1. Is there any other differential diagnosis for stable/chronic tree in bud opacities apart from NTM? I have seen a few scans with mild tree in bud opacities here and there but stable over a course of years but with no documented diagnosis. Could subclinical NTM be a possibility if there is no other differential?
2. What is your recommendation for following up typical IPLN in known pulmonary/extra-pulmonary malignancy. Normally I would dismiss but in the context of known malignancy, what is your approach?
3. Sometimes there are honeycomb cysts which are close to the pleura but 'do not' touch it and their morphology and distribution/pattern is otherwise consistent with UIP. This is particularly seen in patients with co-existing emphysema who start developing this pattern in the mid and lower zones. My question is that do honeycomb cysts always must touch the pleura to be defined as honeycomb cysts? If the answer is yes, then what pattern do you call this type of fibrosis which would otherwise meet UIP pattern criteria?
Thanks a lot for sparing the time!

[Conquest]

The fibrocavitary case where you also described UIP fibrosis, could this just be subpleural bronchiectasis related to the NTM infection rather than a seperate process?