Pulmonary Tuberculosis in Infants: Radiographic and CT Findings

Woo Sun Kim¹, Joon-Il Choi^1 2, Jung-Eun Cheon¹, In-One Kim¹, Kyung Mo Yeon¹ and Hoan Jong Lee³ Show less

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- Affiliations:

¹Department of Radiology, Seoul National University College of Medicine Institute of Radiation Medicine, SNUMRC (Seoul National University Medical Research Center), Seoul, Korea.

²Present address: Department of Radiology, National Cancer Center, 809 Madu-I-dong, Islan dong-gu, Goyang-si, Gryeonggi-do, Korea.

³Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.

Citation: American Journal of Roentgenology. 2006;187: 1024-1033. 10.2214/AJR.04.0751

OBJECTIVE. As complications of tuberculosis are frequent in infancy, correct diagnosis of tuberculosis in infants is important. The purposes of this study are to summarize radiographic and CT findings of pulmonary tuberculosis in infants and to determine the radiologic features frequently seen in infants with this disease.

CONCLUSION. Frequent radiologic findings of pulmonary tuberculosis in infants are mediastinal or hilar lymphadenopathy with central necrosis and air-space consolidations, especially masslike consolidations with low-attenuation areas or cavities within the consolidation. Disseminated pulmonary nodules and airway complications are also frequently detected in this age group. CT is a useful diagnostic technique in infants with tuberculosis because it can show parenchymal lesions and tuberculous lymphadenopathy better than chest radiography. CT scans can also be helpful when chest radiographs are inconclusive or complications of tuberculosis are suspected.

Keywords: chest, CT, infant/neonate, primary tuberculosis, chest radiography, tuberculosis

Fig. 1—4-month-old girl with pulmonary tuberculosis (patient 15). Masslikeconsolidation and bronchial obstruction caused by hilar lymphadenopathy.A, Chest radiograph shows consolidation in right lower lung zone (asterisk) andwidening of right upper mediastinum (arrows).B, Enhanced CT scan shows well-defined, well-enhancing, masslike consolidation inright lower lobe (asterisk). Note low-attenuation lymphadenopathy (arrow)obstructing bronchus intermedius.C, CT scan in lower level of image seen in B shows large consolidation in right middlelobe and right lower lobe. Consolidation is slightly volume expanding. There aremultiple low-attenuation areas (arrows) in consolidation area.

Fig. 2—6-month-old boy with pulmonary tuberculosis (patient 10). Large cavity within consolidation.Chest radiograph shows large cavity within consolidation in right upper lobe (arrow). Multiple nodules are seenin left upper lung field (arrowheads).

Fig. 3—4-month-old girl with systemic disseminated tuberculosis (patient 12).A, Chest radiograph shows multiple disseminated nodules in both lungs and consolidation in left lower lung zone (asterisk).B, Chest CT scan shows disseminated nodules of variable size. Most nodules are larger than 2 mm in diameter.C, Enhanced CT scan shows consolidation with low-attenuation area (arrows) within it in superior segment of left lower lobe.D, Numerous low-attenuation nodules are noted in spleen on enhanced CT scan.

Fig. 4—4-month-old boy with acute disseminated tuberculosis (patient 14). Cavitarychanges in nodules are seen.A, Chest radiograph shows numerous nodules in both lungs. Thin-walled cavity(arrows) is seen in left lower lobe.B, On chest CT, multiple variable-sized nodules are detected. Cavity formation insome nodules is noted (arrows).C, Follow-up chest radiograph obtained 1 year after A and B shows no parenchymalnodule in either lung.

Fig. 5—3-month-old boy (patient 1) with acute disseminated tuberculosis.A, Chest radiograph shows multiple disseminated nodules with random distributionin both lungs.B, Chest CT scan shows multiple small nodules in both lungs.C, On follow-up chest radiograph obtained after antituberculosis medication for 1year, nodules are healed, leaving multiple calcifications. Note multiple calcificationsin spleen (arrows).

Fig. 6—5-month-old girl (patient 2) with bronchogenic spread of tuberculosis and bronchial stenosis.A, Chest radiograph shows left hilar bulging (white arrow) and hyperinflation of left lung. Note narrowing of left main bronchus (black arrows).B, High-resolution CT scan reveals peribronchial infiltrations and peripheral small nodules (arrows) suggesting bronchogenic spread of tuberculosis in left upper lobe.Hyperinflation of left lung is also noted.C, CT scan shows narrowing of left main bronchus (black arrows) by enlarged subcarinal lymph nodes (white arrow).D, Segmental bronchi (white arrow) of left upper lobe are also stenosed by hilar lymph nodes (asterisk). Note enlarged subcarinal lymph node with central low attenuation(black arrows).

Read More: https://www./doi/full/10.2214/AJR.04.0751

TABLE 2: Resolution of Radiographic Findings After Antituberculous Medicationin Patients with Infantile Tuberculosis

TABLE 3: Comparison of Radiographic and CT Features of Pulmonary Tuberculosis in Infancy and Childhood:Literature Review

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