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Diagnosing Pulmonary Tuberculosis with the Xpert MTB/RIF Test
Published on: April 9, 2012
Chest ultrasound findings in children with suspected pulmonary tuberculosis
Charlotte C Heuvelings1,2, Sabine Bélard1,2,3,4, Savvas Andronikou2,5
1Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
Insights
Chest ultrasound effectively identifies abnormalities in pediatric pulmonary tuberculosis (PTB). Findings like pleural effusion and larger lymph nodes were more common in confirmed PTB cases, with slower consolidation resolution observed.
Area of Science:
- Pediatric Pulmonology
- Medical Imaging
- Infectious Diseases
Background:
- Chest ultrasound is increasingly utilized for pediatric lung disease diagnosis.
- Limited data exists on its application in pediatric pulmonary tuberculosis (PTB).
Purpose of the Study:
- To characterize chest ultrasound findings in children with suspected PTB.
- To assess the utility of chest ultrasound in diagnosing PTB in pediatric patients.
Main Methods:
- A cohort study enrolled 170 children with suspected PTB.
- Ultrasound assessments for consolidation, effusion, and lymph nodes were performed and independently reviewed.
- Children were categorized into confirmed, unconfirmed, and unlikely PTB groups.
Main Results:
- Confirmed PTB cases showed higher rates of pleural effusion and larger mediastinal lymph nodes compared to controls.
- Slower resolution of consolidation was observed at 1-month follow-up in confirmed PTB.
- High inter-reader agreement was achieved for ultrasound interpretations.
Conclusions:
- Chest ultrasound is a valuable tool for detecting PTB-suggestive abnormalities in children.
- Slower consolidation resolution on ultrasound indicates confirmed PTB and aids in monitoring treatment response.
Introduction:
Chest ultrasound is increasingly used for the diagnosis of pediatric lung disease but there are limited data for its use in pediatric pulmonary tuberculosis (PTB).
Aim:
To describe chest ultrasound findings in children with suspected PTB.
Methods:
Consecutive children, presenting with suspected PTB to a tertiary children's hospital in Cape Town between July 2014 and March 2016, were enrolled in this cohort study. Children were categorized into three groups based on microbiological and clinical features; confirmed PTB (microbiologically confirmed), unconfirmed PTB (clinical diagnosis only), and unlikely PTB (respiratory disease not due to PTB). A clinician, blinded to categorization, performed chest and mediastinal ultrasound for consolidation, pleural gaps, pleural effusions, B-lines or enlarged mediastinal lymph nodes at enrolment and 1, 3, and 6 months thereafter. Two readers interpreted the ultrasounds independently.
Results:
One hundred seventy children (median age 26.6 months) were enrolled; 40 (24%) confirmed PTB, 85 (50%) unconfirmed PTB, and 45 (26%) unlikely PTB. In children with confirmed PTB, pleural effusion was more common (30% vs 9% in unlikely PTB, P = 0.024), mediastinal lymph nodes were larger (median size 1.5 cm vs 1.0 cm in unlikely PTB, P = 0.027), resolution of consolidation occurred less commonly at 1-month follow-up (24% vs 67% unlikely TB, P = 0.014) and the proportional size reduction of a consolidation was lower (44% vs 80% in unlikely PTB, P = 0.009). Inter-reader agreement was perfect to moderate.
Conclusion:
Chest ultrasound identified abnormalities suggestive of PTB with a high inter-reader agreement. Consolidation showed slower resolution in children with confirmed PTB.
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