Tuberculosis can give a lot of symptoms to a person but there are cases in which patients came to the doctor for other problems and they are discovered this disease too. Sometimes tuberculosis gives only night sweats and the patient will not go to the doctor only for such a mild symptom. Generally extrapulmonary tuberculosis is encountered in those who have a weakened immune system and have other important diseases associated too.
The most affected of extrapulmonary TB and military TB are the patients who have AIDS. In those patients symptoms vary from chest pains and night sweats to morning coughing with blood. In those who are in a bad status loss of weight may be encountered along with these other symptoms. At the physical exam the doctor will hear with his stethoscope diminished breath sounds and coarse crackles.
It is not easy to diagnose tuberculosis as the symptoms can be found in other diseases too, like: lung cancer, asperigollosis, pneumonia, sarcoidosis, pneumoconiosis, diabetes mellitus, hyperthyroidism and mediastinial lymphadenopathy.
The doctor will ask for a thoracic X-ray. If tuberculosis is present on the thoracic X-ray cavitation, calcification and nodes will be seen. Other tests must me done to be sure the disease is tuberculosis. A biopsy is indicated also, and if it shows granulomas and caseation then there is a confirmation of tuberculosis. Sputum can also be tested to see if it contains the Koch bacteria. If the tuberculosis is not localized in the lungs then the urine can be taken as a sample and analyzed or the LCR or even the blood. The lymph noses biopsy can be made because tuberculosis can shed there too. If the doctor thinks the tuberculosis affected some other organisms he will take a sample of liquid from the pleural space, the pericardial space, or the peritoneal space.
In those patients in which the sputum test got negative the bronchoalveolar lavage can be tested too to eliminate any possibility of misdiagnosing. This is done with an optic bronchoscope which is passed from the mouth or the nose towards the trachea and then the lungs. This procedure is not painful as the doctor uses a lidocaine spray to locally sedate the patient. With the bronchoscope a sample will be taken from the alveolar space as a saline solution will be entered the lungs to flush out bacteria and loose cells. This solution will be collected and tested in the end of the procedure.
With the help of the bronchoscope biopsy can be performed from small tissue samples from the bronchi. These samples will be analyzed in the laboratory to see if they are infected with the Koch bacilli.