Complicated pleural tuberculosis in children: CT evaluation

Abstract

Purpose: To describe the CT features of complicated pleural tuberculosis in children and to define the use of CT in children with pleural tuberculosis.

Materials and methods: The CT findings in 11 children with complicated pleural tuberculosis were retrospectively analysed. CT was performed to evaluate persistent pleural thickening (n = 6) or a mass-like lesion (n = 5) detected on plain radiographs. Chest radiographs and medical records were reviewed to determine whether additional information provided by CT had altered clinical management.

Results: On CT, more than one location was involved in five patients (45%) and in two patients (18%) the entire pleural spaces were involved. Pleural thickening was seen in all 11 patients and enhancement after administration of contrast medium occurred in ten patients (91%). Low-density fluid collections were seen in nine patients (82%) and in two, CT revealed fluid collections within calcified pleural lesions. In five patients with mass-like lesions on plain radiographs, CT showed a low-density pleural mass with peripheral enhancement in four and a calcified pleural mass with fluid collection in one. CT demonstrated parenchymal abnormalities on the same side as pleural lesions in all 11 patients and hilar or mediastinal adenopathy in four. Four patients (36%) underwent surgery because of fluid within a calcified fibrothorax (n = 3) and chest wall tuberculosis (n = 1) that were seen only on CT.

Conclusions: The CT features of complicated pleural tuberculosis in children were pleural thickening, enhancement and fluid collection with associated parenchymal abnormalities and lymphadenopathy. In the evaluation of children with pleural tuberculosis, CT can be useful for demonstrating fluid within a calcified fibrothorax or chest wall involvement, which usually requires surgical intervention.