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Assessment of airway compression on chest radiographs in children with pulmonary tuberculosis

Lisel Richter-Joubert1, Savvas Andronikou2,3, Lesley Workman4

  • 1Department of Radiology, Groote Schuur Hospital and University of Cape Town, Main Rd, Observatory, Cape Town, 7935, South Africa. liselrichter@gmail.com.

Pediatric Radiology
|May 31, 2017
PubMed

Insights

Airway compression on chest radiographs is strongly linked to childhood pulmonary tuberculosis. However, inconsistent readings between doctors limit its use as a diagnostic tool.

Area of Science:

  • Pediatric Radiology
  • Infectious Diseases
  • Pulmonary Medicine

Background:

  • Paediatric airways are susceptible to compression by enlarged lymph nodes.
  • Radiographic evidence of airway compression may serve as an objective diagnostic marker for pulmonary tuberculosis in children.

Purpose of the Study:

  • To determine the frequency and inter-observer agreement of airway compression on chest radiographs.
  • To compare findings in children with pulmonary tuberculosis versus other lower respiratory tract infections.

Main Methods:

  • Two independent readers analyzed chest radiographs of children with suspected pulmonary tuberculosis using a standardized format.
  • Findings were compared between children with confirmed pulmonary tuberculosis and those with other lower respiratory tract infections.
  • Inter-observer agreement was assessed using kappa statistics and correlated with HIV status and age.

Main Results:

  • Airway compression was observed in 28.7% of children with pulmonary tuberculosis versus 7.6% with other infections (OR 4.9).
  • Infants showed a higher frequency of airway compression (21.8%) compared to older children (13.9%).
  • Inter-observer agreement for detecting airway compression was poor, ranging from 0.0 to 0.4.

Conclusions:

  • A significant association exists between airway compression on chest radiographs and confirmed pulmonary tuberculosis in children.
  • Poor inter-observer agreement limits the clinical utility of radiographic airway compression as a standalone diagnostic criterion for pediatric pulmonary tuberculosis.
Abstract

Keywords:
Airway compressionChest radiographyChildrenInter-observer agreementLymphobronchial tuberculosisPulmonary tuberculosis

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