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Chest ultrasound findings in children with suspected pulmonary tuberculosis
Author(s) -
Heuvelings Charlotte C.,
Bélard Sabine,
Andronikou Savvas,
JamiesonLuff Norme,
Grobusch Martin P.,
Zar Heather J.
Publication year - 2019
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.24230
Subject(s) - medicine , pleural effusion , ultrasound , tuberculosis , pulmonary tuberculosis , radiology , respiratory disease , cohort , lung , pediatrics , pathology
Chest ultrasound is increasingly used for the diagnosis of pediatric lung disease but there are limited data for its use in pediatric pulmonary tuberculosis (PTB). Aim To describe chest ultrasound findings in children with suspected PTB. Methods Consecutive children, presenting with suspected PTB to a tertiary children's hospital in Cape Town between July 2014 and March 2016, were enrolled in this cohort study. Children were categorized into three groups based on microbiological and clinical features; confirmed PTB (microbiologically confirmed), unconfirmed PTB (clinical diagnosis only), and unlikely PTB (respiratory disease not due to PTB). A clinician, blinded to categorization, performed chest and mediastinal ultrasound for consolidation, pleural gaps, pleural effusions, B‐lines or enlarged mediastinal lymph nodes at enrolment and 1, 3, and 6 months thereafter. Two readers interpreted the ultrasounds independently. Results One hundred seventy children (median age 26.6 months) were enrolled; 40 (24%) confirmed PTB, 85 (50%) unconfirmed PTB, and 45 (26%) unlikely PTB. In children with confirmed PTB, pleural effusion was more common (30% vs 9% in unlikely PTB, P = 0.024), mediastinal lymph nodes were larger (median size 1.5 cm vs 1.0 cm in unlikely PTB, P = 0.027), resolution of consolidation occurred less commonly at 1‐month follow‐up (24% vs 67% unlikely TB, P = 0.014) and the proportional size reduction of a consolidation was lower (44% vs 80% in unlikely PTB, P = 0.009). Inter‐reader agreement was perfect to moderate. Conclusion Chest ultrasound identified abnormalities suggestive of PTB with a high inter‐reader agreement. Consolidation showed slower resolution in children with confirmed PTB.