Radiological aspects in computed tomography as determinants in the diagnosis of pulmonary tuberculosis in immunocompetent infants

Abstract

Objective: To describe the chest computed tomography (CT) findings in immunocompetent children under 36 months of age with pulmonary tuberculosis.

Materials and methods: This was a descriptive case series conducted in the city of Rio de Janeiro, Brazil, between January 2004 and July 2013, involving 20 young children who underwent CT after undergoing chest X-rays that did not provide a definitive diagnosis.

Results: All of the participants had lymph node enlargement and consolidations. In 15 cases (75%), the consolidations were accompanied by atelectasis. Pulmonary cavitation was seen in 10 cases (50%), and cavitation within consolidations was seen in 7 (35%). The areas of cavitation and parenchymal destruction were not seen on conventional chest X-rays.

Conclusion: The radiological presentation of pulmonary tuberculosis in young children differs from that described in older children and adults. CT is an effective method for the early diagnosis of pulmonary tuberculosis in immunocompetent infants, allowing the rapid institution of specific treatment, which is crucial for halting disease progression, as well as for preventing local and systemic complications.

Keywords: Children; Computed tomography; Tuberculosis, pulmonary.

Figure 1

Contrast-enhanced CT, with soft-tissue window settings, of na eight-month-old infant, showing right paratracheal retrocaval lymph node enlargement with a hypodense core and peripheral contrast enhancement, suggestive of central necrosis.

Figure 2

Noncontrast CT, with soft-tissue window settings, of a five-monthold infant, showing consolidation, containing air bronchograms and cavitation, in the posterior basal segment of the right lower lobe. Note the enlarged subcarinal lymph nodes with calcifications.

Figure 3

CT, with lung parenchymal window settings, showing a consolidation, with an atelectatic component and an area of cavitation, in the right lower lobe. A ground-glass opacity can be seen in the left lower lobe.

Figure 4

CT, with lung parenchymal window settings, of a three-month-old infant, showing bullous lesions with expansile features in the right lower lobe and consolidation with an atelectatic component in the left lower lobe. Note the respiratory motion artifacts in the retrosternal region.

Figure 5

Pulmonary tuberculosis presenting as a pseudotumor in a threemonth-old infant. Contrast-enhanced CT, with soft-tissue window settings, showing enlarged hypodense lymph nodes-pretracheal, right paratracheal, and caval-aortic-with expansile features, forming a mass that partially compressed the right primary bronchus. Note the consolidations in the upper lobes and in the apical segment of the left lower lobe.

Figure 6

CT, with lung parenchymal window settings, of a five-month-old infant, showing randomly distributed (miliary) nodules in both lungs. Note the area of consolidation containing cavitation in the posterior basal segment of the right lower lobe. Another thin-walled cavitation can be seen in the lingula.

Figure 7

CT, with lung parenchymal window settings, of a two-month-old infant, showing airspace nodules, ranging in size from 5 mm to 10 mm, diffusely distributed in both lungs, together with consolidations containing cavitations in the lower lobes.