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Complicated pleural tuberculosis in children: CT evaluation
1Department of Radiology, College of Medicine Seoul National University, Chongno-Gu, Korea.
Insights
Computed tomography (CT) effectively identifies complicated pleural tuberculosis in children, revealing pleural thickening, enhancement, and fluid collections. This imaging modality aids in diagnosing conditions requiring surgical intervention, such as calcified fibrothorax or chest wall involvement.
Area of Science:
- Pediatric Radiology
- Infectious Diseases Imaging
- Thoracic Imaging
Background:
- Pleural tuberculosis (TB) in children can present with complex radiological findings.
- Accurate diagnosis and management of pediatric pleural TB are crucial for patient outcomes.
- Computed tomography (CT) plays a role in evaluating thoracic abnormalities.
Purpose of the Study:
- To delineate the characteristic CT features of complicated pleural tuberculosis in pediatric patients.
- To assess the utility of CT in the diagnostic and management pathway for children with pleural TB.
Main Methods:
- Retrospective analysis of CT findings in 11 children diagnosed with complicated pleural TB.
- CT was utilized to further investigate persistent pleural thickening or mass-like lesions identified on plain radiographs.
- Review of chest radiographs and medical records to determine CT's impact on clinical management.
Main Results:
- CT demonstrated pleural thickening in all 11 patients, with enhancement observed in 91%.
- Low-density fluid collections were present in 82% of cases, sometimes within calcified pleural lesions.
- CT revealed associated parenchymal abnormalities in all patients and identified specific findings like calcified fibrothorax or chest wall TB in four patients, leading to surgical intervention.
Conclusions:
- Key CT findings in pediatric complicated pleural TB include pleural thickening, enhancement, and fluid collections, often with accompanying parenchymal changes and lymphadenopathy.
- CT is valuable for detecting subtle but clinically significant findings such as fluid within calcified fibrothorax or chest wall TB, guiding surgical management.
Purpose:
To describe the CT features of complicated pleural tuberculosis in children and to define the use of CT in children with pleural tuberculosis.
Materials And Methods:
The CT findings in 11 children with complicated pleural tuberculosis were retrospectively analysed. CT was performed to evaluate persistent pleural thickening (n = 6) or a mass-like lesion (n = 5) detected on plain radiographs. Chest radiographs and medical records were reviewed to determine whether additional information provided by CT had altered clinical management.
Results:
On CT, more than one location was involved in five patients (45%) and in two patients (18%) the entire pleural spaces were involved. Pleural thickening was seen in all 11 patients and enhancement after administration of contrast medium occurred in ten patients (91%). Low-density fluid collections were seen in nine patients (82%) and in two, CT revealed fluid collections within calcified pleural lesions. In five patients with mass-like lesions on plain radiographs, CT showed a low-density pleural mass with peripheral enhancement in four and a calcified pleural mass with fluid collection in one. CT demonstrated parenchymal abnormalities on the same side as pleural lesions in all 11 patients and hilar or mediastinal adenopathy in four. Four patients (36%) underwent surgery because of fluid within a calcified fibrothorax (n = 3) and chest wall tuberculosis (n = 1) that were seen only on CT.
Conclusions:
The CT features of complicated pleural tuberculosis in children were pleural thickening, enhancement and fluid collection with associated parenchymal abnormalities and lymphadenopathy. In the evaluation of children with pleural tuberculosis, CT can be useful for demonstrating fluid within a calcified fibrothorax or chest wall involvement, which usually requires surgical intervention.