Radiologic Manifestation of Pulmonary Tuberculosis in Children Admitted in Pediatric Ward-Massih Daneshvari Hospital: A 5-Year Retrospective Study

Abstract

Despite the extensive preventive and therapeutic measures present against tuberculosis (TB), this disease still remains as one of the important causes of mortality and morbidity in the world. Considering the high incidence of TB in children, rareness of its' clinical features and complexity of bacteriologic diagnosis in this age group paraclinical studies, especially radiologic evaluations, is useful for reaching a final diagnosis. This 5 year study was conducted in National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Massih Daneshvari Hospital, Tehran, Iran. This retrospective study was conducted on 70 children (43 (61%) female and 27 (38.5%) male) aged between 5 months to 15 years old during a five year period (from 2001-2006) in pediatric ward. It was performed on children who were confirmed to have TB by various clinical, bacteriologic and radiologic features and tuberculin skin test. We studied the radiologic features of pulmonary TB in these children. Right lung involvement was observed in 65%, left lung 23% and bilateral involvement was detected in 12%. Also middle and superior lobes were the most common lobes affected. The commonest radiographic feature was hilar (mediastinal) lymphadenopathy; 70% detected on chest x-ray (CXR) and 85% on CTscan. Lymph nodes on right side were affected more; 25% were calcified. Also nodular infiltration of lung parenchyma was observed in 35% of CXRS and 61% of CTscans. This was followed by patchy consolidation detected in 25% and 35% of CXRs and CTscans respectively. We also observed that children <3yr. of age had the highest lymph node involvement but the least parenchymal lesions as compared to older children. It is concluded that primary TB is the most common form of pulmonary TB in children. This could be in the form of hilar lymphadenopathy with or without lung parenchymal involvement. Also radiologic features could provide valuable information in regard to diagnosis, treatment and follow-up of pulmonary TB in children.