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[Thoracic standard radiology and x-ray computed tomography in mediastino-pulmonary tuberculosis in infants]
B Bourlière-Najean1, M D Boespflug, J C Dubus
1Service de Radiologie Pédiatrique, Hôpital d'Enfants, CHU Timone, Marseille.
Insights
Pediatric tuberculosis diagnosis in infants is challenging. Chest X-rays and CT scans are valuable tools, with CT scans offering superior detail for identifying mediastinal and pulmonary tuberculosis.
Area of Science:
- Pediatric Radiology
- Infectious Diseases
- Pulmonology
Background:
- Increasing incidence of primary mediastinal and pulmonary tuberculosis in infants in France.
- Difficulties associated with bacteriological diagnosis of tuberculosis in this age group.
- Need for effective imaging modalities to aid in diagnosis.
Purpose of the Study:
- To evaluate the diagnostic utility of chest radiography and computed tomography (CT) scans for infant tuberculosis.
- To compare the findings of plain film radiography with CT scans in diagnosing pediatric tuberculosis.
Main Methods:
- Retrospective study of 15 infants (3-18 months old) diagnosed with tuberculosis between November 1990 and June 1992.
- Analysis of plain chest radiographs and CT scans for characteristic signs of tuberculosis.
- Comparison of imaging findings with eventual diagnosis.
Main Results:
- Plain radiography showed lymphadenopathy (13/15), parenchymal disease (10/15), nodular densities (6/15), and pleural effusion (1/15).
- CT scan revealed lymphadenopathy in all cases, often right-sided, typically hypodense with peripheral enhancement.
- CT scan identified abnormalities missed by plain films in 4 cases (2 lymphadenopathy, 2 alveolar consolidation).
Conclusions:
- CT scan is crucial for delineating mediastinal and pulmonary changes in infant tuberculosis.
- The combination of right paratracheal nodes, tracheal displacement, and alveolar consolidation on chest radiographs strongly suggests tuberculosis.
- CT scan is recommended when suggestive findings are present on chest radiographs to confirm the diagnosis.
Abstract:
Primary mediastino pulmonary tuberculosis in infancy is increasing in France. Bacteriological diagnosis is difficult. The aim of the study is to assess the value of chest radiograph and CTscan for diagnosis of tuberculosis. We studied 15 infants, 3 month old to 18 month old, between November 1990 and June 1992. On plain film, lymphadenopathies were present in 13 cases and parenchymal disease in 10 cases, parenchymal nodular densities in 6 cases and pleural effusion in one case, displacement of the trachea in 6 cases. We found CTscan to be useful in delineating the lymphadenopathies and parenchymal changes. In 2 cases lymphadenopathies and in 2 cases alveolar condensation were discovered on CTscan as plain film was normal. In all cases lymphadenopathies were present in CTscan, often in right side and in all cases, lymphadenopathies were hypodense with peripheral enhancement. In conclusion, the association of right paratracheal nodes with displacement of trachea and alveolar consolidation is common in tuberculosis in infants. These findings when seen on chest radiographs must lead to perform a CTscan and suggest the diagnosis.