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The radiography, haematology and biochemistry of pulmonary tuberculosis in the aged.

Ninety-three elderly patients with pulmonary tuberculosis were surveyed prospectively to determine the extent and severity of radiological, haematological and biochemical abnormalities. Radiological features of inflammatory 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 occurred 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. Thus radiographs 'atypical' for pulmonary tuberculosis were usual with the major changes being basal and peripheral. Haematological abnormalities were normochromic normocytic anaemia (66 per cent), neutrophilia (69 per cent), thrombocytosis (33 per cent), rapid erythrocyte sedimentation rate (90 per cent), and lymphocytopenia and monocytosis in 22 and 28 per cent respectively. Biochemical abnormalities were hyponatraemia (60 per cent), hypokalaemia (42 per cent), hypoalbuminaemia (83 per cent), and (before treatment) elevation of bilirubin (20 per cent), alkaline phosphatase (62 per cent), aspartic transaminase (77 per cent) and lactic dehydrogenase (74 per cent). The abnormal liver function tests may reflect unsuspected extrapulmonary 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 any of these haematological and biochemical abnormalities should raise suspicion of the disease.