Tuberculosis revisted: classic imaging findings in childhood

Area of Science:

• Radiology
• Pediatrics
• Infectious Diseases

Background:

• Tuberculosis (TB) remains a significant global public health challenge, particularly impacting pediatric populations with high morbidity and mortality.
• Diagnosing childhood TB, especially pulmonary TB, is difficult due to challenges in microbiological confirmation, often necessitating reliance on clinical and radiological assessments.
• Extrapulmonary TB manifestations, including central nervous system, spinal, musculoskeletal, abdominal, and genitourinary involvement, present diverse and sometimes subtle radiological findings.

Approach:

• This article provides a comprehensive review of the classic radiological findings associated with childhood tuberculosis.
• The review systematically covers major organ systems, prioritizing those with higher clinical prevalence: chest, central nervous system, spine, musculoskeletal, abdomen, and genitourinary system.
• Emphasis is placed on understanding imaging characteristics to facilitate early and accurate diagnosis in pediatric TB cases.

Key Points:

• Pulmonary TB diagnosis in children often relies on clinical and radiological data due to microbiological confirmation challenges.
• Central nervous system TB diagnosis is challenging, with imaging crucial for identifying leptomeningitis, tuberculomas, or abscesses.
• Musculoskeletal TB, though less common, includes spondylitis, arthritis, and osteomyelitis, often with non-specific imaging findings.
• Abdominal TB presents with pain, fever, and weight loss, and concomitant pulmonary TB should be considered.
• Urogenital TB is rare in children, but radiological assessment remains important.

Conclusions:

• Radiological findings are critical for diagnosing various forms of tuberculosis in children, especially when microbiological confirmation is elusive.
• Recognizing classic imaging patterns across different systems is essential for timely and effective management of pediatric TB.
• This review serves as a guide to the radiological spectrum of childhood TB, aiding clinicians in diagnosis and treatment planning.