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Radiological patterns of childhood thoracic tuberculosis in a developed country: a single institution’s experience on 217/255 cases

  • CHEST RADIOLOGY
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Abstract

The incidence of tuberculosis is increasing in the developed world and children in particular represent a high-risk group for developing the disease. The aim of this review is to analyse the spectrum of radiological signs as reported in the recent literature, in light of our series over a 15-year period, to pinpoint the most common radiological patterns in a developed country and to determine the role played by the different chest imaging techniques in diagnosis improvement. Lung TB was present in 217 out of 255 patients (85 %): 146 patients were under 5 years of age (76 under 2 years) and 71 over 5 years (41 over 10 years). We describe different patterns differentiating adolescents and young adults from infants and children. Adolescents and young adult tuberculosis are apical and cavitary. Thoracic TB in infants and children is characterized by lymph node and parenchymal disease. In 21 cases with lymphadenopathies without lymph-bronchial diffusion (age range 2 months–7 years), CT identified the Ghon focus in 16/21 cases; chest X-ray never identified the Ghon focus. In our series, pleural TB was present in 8 cases out of 146 under 5 years of age, 5 cases out of 76 under 2 years, and 18 cases out of 71 over 5 years. Radiologists should be aware of typical patterns of tuberculosis, to provide an early diagnosis.

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References

  1. Di Comite A, Esposito S, Villani A, Stronati M, Italian Pediatric TB Study Group et al (2016) How to manage neonatal tuberculosis. J Perinatol 36:80–85

    Article  PubMed  Google Scholar 

  2. Chiappini E, Lo Vecchio A, Garazzino S, Marseglia GL, Bernardi F, Castagnola E, Tomà P, Cirillo D, Russo C, Gabiano C, Ciofi D, Losurdo G, Bocchino M, Tortoli E, Tadolini M, Villani A, Guarino A, Esposito S, Italian Pediatric TB Study Group et al (2016) Recommendations for the diagnosis of pediatric tuberculosis. Eur J Clin Microbiol Infect Dis 35:1–18

    Article  CAS  PubMed  Google Scholar 

  3. Principi N, Galli L, Lancella L, Tadolini M, Migliori GB, Villani A, Esposito S, Italian Pediatric TB Study Group (2016) Recommendations concerning the first-line treatment of children with tuberculosis. Paediatr Drugs 18:13–23

    Article  PubMed  Google Scholar 

  4. Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, Kaplan SL, Mace SE, McCracken GH, Moore MR, St Peter SD, Stockwell JA, Swanson JT, Pediatric Infectious Diseases Society and the Infectious Diseases Society of America (2011) The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis 53:25–76

    Article  Google Scholar 

  5. Marais BJ, Gie RP, Schaaf HS, Beyers N, Donald PR, Starke JR (2006) Childhood pulmonary tuberculosis: old wisdom and new challenges. Am J Respir Crit Care Med 173:1078–1090

    Article  PubMed  Google Scholar 

  6. Marais BJ (2008) Tuberculosis in children. Pediatr Pulmonol 43:322–329

    Article  PubMed  Google Scholar 

  7. Khan AE, Starke JR (1995) Diagnosis of tuberculosis in children: increased need for better methods. Emerg Infect Dis 1:115–123

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Zar HJ, Hanslo D, Apolles P, Swingler G, Hussey G (2005) Induced sputum versus gastric lavage for microbiological confirmation of pulmonary tuberculosis in infants and young children: a prospective study. Lancet 365:130–134

    Article  PubMed  Google Scholar 

  9. Mixides G, Shende V, Teeter LD, Awe R, Musser JM, Graviss EA (2005) Number of negative acid-fast smears needed to adequately assess infectivity of patients with pulmonary tuberculosis. Chest 128:108–115

    Article  PubMed  Google Scholar 

  10. Donald PR, Ball JB, Burger PJ (1985) Bacteriologically confirmed pulmonary tuberculosis in childhood. Clinical and radiological features. S Afr Med J 13:588–590

    Google Scholar 

  11. Lamont AC, Cremin BJ, Pelteret RM (1986) Radiological patterns of pulmonary tuberculosis in the paediatric age group. Pediatr Radiol 16:2–7

    Article  CAS  PubMed  Google Scholar 

  12. Burrill J, Williams CJ, Bain G, Conder G, Hine AL, Misra RR (2007) Tuberculosis: a radiologic review. Radiographics 27:1255–1273

    Article  PubMed  Google Scholar 

  13. Leung AN (1999) Pulmonary tuberculosis: the essentials. Radiology 210:307–322

    Article  CAS  PubMed  Google Scholar 

  14. Leung AN, Müller NL, Pineda PR, FitzGerald JM (1992) Primary tuberculosis in childhood: radiographic manifestations. Radiology 182:87–91

    Article  CAS  PubMed  Google Scholar 

  15. Andronikou S, Vanhoenacker FM, De Backer AI (2009) Advances in imaging chest tuberculosis: blurring of differences between children and adults. Clin Chest Med 30:717–744

    Article  PubMed  Google Scholar 

  16. Thomas KE (2011) CT utilization-trends and developments beyond the United States’ borders. Pediatr Radiol 41(Suppl 2):S562–S566

    Article  Google Scholar 

  17. Ciet P, Tiddens HA, Wielopolski PA, Wild JM, Lee EY, Morana G, Lequin MH (2015) Magnetic resonance imaging in children: common problems and possible solutions for lung and airways imaging. Pediatr Radiol 45:1901–1915

    Article  PubMed  PubMed Central  Google Scholar 

  18. Smuts NA, Beyers N, Gie RP, Schaaf HS, Talent JM, Nel E, van Zyl S, Donald PR (1994) Value of the lateral chest radiograph in tuberculosis in children. Pediatr Radiol 24:478–480

    Article  CAS  PubMed  Google Scholar 

  19. Swingler GH, du Toit G, Andronikou S, van der Merwe L, Zar HJ (2005) Diagnostic accuracy of chest radiography in detecting mediastinal lymphadenopathy in suspected pulmonary tuberculosis. Arch Dis Child 90:1104

    Article  Google Scholar 

  20. Lee EY, Tracy DA, Eisenberg RL, Arellano CM, Mahmood SA, Cleveland RH, Zurakowski D, Boiselle PM (2011) Screening of asymptomatic children for tuberculosis is a lateral chest radiograph routinely indicated? Acad Radiol 18:184–190

    Article  PubMed  Google Scholar 

  21. Rigsby CK, Strife JL, Johnson ND, Atherton HD, Pommersheim W, Kotagal UR (2004) Is the frontal radiograph alone sufficient to evaluate for pneumonia in children? Pediatr Radiol 34:379–383

    Article  PubMed  Google Scholar 

  22. World Health Organization (2016) Communicating radiation risks in paediatric imaging. http://www.who.int/ionizing_radiation/pub_meet/radiation-risks-paediatric-imaging/en/. Accessed 8 Sept 2016

  23. Garrido JB, Alías Hernández I, Bonillo Perales A, Rubí Ruiz T, González Jiménez Y, González-Ripoll Garzón M, Moriana Maldonado J, González de Rojas JD, Martínez Lirola M, Fornovi Vives JJ (2012) Usefulness of thoracic CT to diagnose tuberculosis disease in patients younger than 4 years of age. Pediatr Pulmonol 47:895–902

    Article  PubMed  Google Scholar 

  24. Shinn-Forng Peng S, Chan Pei-Chun, Chang Yeun-Chung, Ting-Fang Shih T (2011) Computed tomography of children with pulmonary Mycobacterium tuberculosis infection. J Formos Med Assoc 110:744–749

    Article  Google Scholar 

  25. Peprah KO, Andronikou S, Goussard P (2012) Characteristic magnetic resonance imaging low T2 signal intensity of necrotic lung parenchyma in children with pulmonary tuberculosis. J Thorac Imaging 27:171–174

    Article  PubMed  Google Scholar 

  26. Sodhi KS, Khandelwal N, Saxena AK, Singh M, Agarwal R, Bhatia A, Lee EY (2015) Rapid lung MRI in children with pulmonary infections: time to change our diagnostic algorithms. J Magn Reson Imaging 43:1196–1206

    Article  PubMed  Google Scholar 

  27. Marais BJ, Gie RP, Schaaf HS, Starke JR, Hesseling AC, Donald PR, Beyers N (2004) A proposed radiological classification of childhood intra-thoracic tuberculosis. Pediatr Radiol 34:886–894

    Article  PubMed  Google Scholar 

  28. Aderele WI (1980) Radiological patterns of pulmonary tuberculosis in Nigerian children. Tubercle 61:157–163

    Article  CAS  PubMed  Google Scholar 

  29. Van Dyck P, Vanhoenacker FM, Van den Brande P, De Schepper AM (2003) Imaging of pulmonary tuberculosis. Eur Radiol 13:1771–1785

    Article  PubMed  Google Scholar 

  30. Lucas S, Andronikou S, Goussard P, Gie R (2012) CT features of lymphobronchial tuberculosis in children, including complications and associated abnormalities. Pediatr Radiol 42:923–931

    Article  PubMed  Google Scholar 

  31. De Jong PA, Nievelstein RJ (2012) Normal mediastinal and hilar lymph nodes in children on multi detector row chest computed tomography. Eur Radiol 22:318–321

    Article  PubMed  Google Scholar 

  32. Jeong YJ, Lee KS (2008) Pulmonary tuberculosis: up-to-date imaging and management. AJR Am J Roentgenol 191:834–844

    Article  PubMed  Google Scholar 

  33. Andreu J, Cáceres J, Pallisa E, Martinez-Rodriguez M (2004) Radiological manifestations of pulmonary tuberculosis. Eur J Radiol 51:139–149

    Article  CAS  PubMed  Google Scholar 

  34. Yilmaz MU, Kumcuoglu Z, Utkaner G, Yalniz O, Erkmen G (1998) CT findings of tuberculous pleurisy. Int J Tuberc Lung Dis 2:164–167

    CAS  PubMed  Google Scholar 

  35. Mayosi BM, Volmink JA, Commerford PJ (2000) Interventions for treating tuberculous pericarditis. Cochrane Database Syst Rev 2:CD000526. Update in: Cochrane Database Syst Rev. 2002;4:CD000526

  36. Griffith-Richards SB, Goussard P, Andronikou S, Gie RP, Przybojewski SJ, Strachan M, Vadachia Y, Kathan DL (2007) Cavitating pulmonary tuberculosis in children: correlating radiology with pathogenesis. Pediatr Radiol 37:798–804

    Article  PubMed  Google Scholar 

  37. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J (2008) Fleischner Society: glossary of terms for thoracic imaging. Radiology 246:697–722

    Article  PubMed  Google Scholar 

  38. Bhalla AS, Goyal A, Guleria R, Gupta AK (2015) Chest tuberculosis: radiological review and imaging recommendations. Indian J Radiol Imaging 25:213–225

    Article  PubMed  PubMed Central  Google Scholar 

  39. Kim SH, Min JH, Lee JY (2014) Radiological findings of primary multidrug-resistant pulmonary tuberculosis in HIV-seronegative patients. Hong Kong J Radiol 17:4–8

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Imaging, Bambino Gesù Children Hospital, IRCCS, Rome, Italy

    Paolo Tomà, Laura Menchini, Roberta Lombardi & Aurelio Secinaro

  2. Paediatrics and Infectious Disease, Bambino Gesù Children Hospital, IRCCS, Rome, Italy

    Laura Lancella & Alberto Villani

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  1. Paolo Tomà
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  2. Laura Lancella
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  3. Laura Menchini
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  4. Roberta Lombardi
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  6. Alberto Villani
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Correspondence to Paolo Tomà.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Tomà, P., Lancella, L., Menchini, L. et al. Radiological patterns of childhood thoracic tuberculosis in a developed country: a single institution’s experience on 217/255 cases. Radiol med 122, 22–34 (2017). https://doi.org/10.1007/s11547-016-0683-9

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  • DOI: https://doi.org/10.1007/s11547-016-0683-9

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