Approximately 60 children have been treated from tuberculosis in our general hospital during year 2010.
and 2011.
We reviewed chest x-rays of 5 children and a chest CT scan of one of those children.
Frontal and lateral chest radiographs were performed as well as contrast enhanced chest CT scan using dual- slice CT scanner.
Diagnosis of TB had been established by clinical and radiological findings,
contact with a relative with proved TB infection,
positive PPD test,
positive Quantiferon test,
positive culture for acid-fast bacilli and response to anti TB drugs.
CASE 1:
A 10 year old boy was admitted for treatment because of a positive tuberculin skin test (induration diameter 30 mm),
a history of positive TB contact and subfebrile body temperature (37,5°C).
Bacteriological tests for M.
tuberculosis were negative.
Chest x ray was normal (Fig.1).
Concerning close contact with the person who had active TB disease,
subfebrile temperatures and extremely large induration of tuberculin skin test it was considered to be a subclinical primary disease and the patient went through with the treatment.
Two months after the beginning of treatment,
the boy was feeling well and had no clinical symptoms.
Fig. 1: Normal PA chest x-ray
CASE 2:
A 12 year old girl was admitted for treatment because of erythema nodosum followed by moderate fever (38.6°C) and cough.
Laboratory values showed anemia of chronic disease,
increased CRP 30 mg/L (normal value ˂ 5 mg/L) and ESR 32 mm/ hour (normal values 3 – 13 mm/ hour).
TB contact was her brother.
Tuberculin skin test showed induration diameter of 17 mm.
Bacteriological tests for M.
tuberculosis were negative.
The initial chest radiograph on admission (Fig.2) was an enlarged right hilar gland.
Follow-up chest radiograph 2 and 4 months after the beginning of treatment showed no improvement (Fig.3,
Fig.4). At the end of treatment the chest X-ray was normal (Fig.5).
She was diagnosed with primary TB.
Fig. 2: Chest x-ray,PA view, on admission showing right hilar adenopathy
Fig. 3: Follow-up PA chest x-ray performed two months after the beginning of treatment showing persistent right hilar adenopathy
Fig. 4: Follow-up PA chest x-ray performed four months after the beginning of treatment showing no improvement
Fig. 5: Follow-up PA chest x-ray performed at the end of treatment showing regression of right hilar adenopathy
CASE 3:
A 15 year old boy complained of chest pain when moving and taking a breath in.
He also had moderate fever (38.7-39°C) that lasted for a week and was coughing productively.
He is a smoker (smoking 20 cigarettes a day).
Initial chest X-ray on admission showed pulmonary consolidation with central cavitation and a fluid level formation in the right upper lung lobe (Fig.6).
Laboratory tests showed mildly increased CRP 11 mg/ L (normal values ˂ 5 mg/L).
Tuberculin skin test showed induration diameter of 19 mm.
Sputum smear and culture for acid- fast bacilli were positive.
TB contacts were the boy’s parents who had active disease several years ago.
Follow-up radiographs showed regression of abnormalities (Fig.7,
Fig.8). He was diagnosed with postprimary tuberculosis (pulmonary phthisis).
Fig. 6: Chest x-ray, PA and lateral views,on admission showing a right upper lobe pulmonary consolidation with central cavitation and a fluid level formation
Fig. 7: Follow-up PA chest x-ray performed one month after the beginning of treatment showing an inhomogenous opacity with a cavitation in the right upper lung field
Fig. 8: Follow-up PA chest x-ray performed four months after the beginning of treatment showing residual thin walled cavity in the right upper lung field
CASE 4:
An 18 year old girl had a productive cough lasting 2 months.
She lost 15 kg in the past year and complained of fatigue.
Her father had TB disease one year before she was admitted for treatment.
Sputum smear and culture were positive.
Tuberculin skin test showed induration diameter of 9 mm.
Chest X-ray showed bilateral inhomogeneous opacities and parenchyma destruction (Fig.9). A chest CT scan showed patchy,
ill-defined consolidations with multiple nodules and cavitations predominantly in the upper lung lobes (Fig.10). She was diagnosed with postprimary TB.
Fig. 9: Initial PA chest x-ray showing bilateral inhomogenous opacities and parenchyma destruction
References: Radiology, Dom zdravlja Županja - 32270 / HR
Fig. 10: Chest CT, pulmonary window, showing patchy, poorly defined consolidations with multiple nodules and cavitations in both upper lung lobes
CASE 5:
A 16 year old boy,
a smoker (smoking 10 cigarettes a day) was coughing for two months,
had fever and felt very tired.
He lost weight (5-6 kg in 5 months).
On admission his chest X-ray showed confluent opacities in both upper lobes (Fig.11). Laboratory values showed increased CRP 55 mg/ L (normal values ˂ 5mg/L).
Tuberculin skin test showed induration diameter of 20 mm.
Quantiferon test was positive.
Sputum smear and culture were positive.
His parents had TB disease several years ago.
One month after the beginning of treatment chest radiograph showed incomplete regression of abnormalities (Fig.12).
He was diagnosed with postprimary tuberculosis.
Fig. 11: Chest x-ray, PA and lateral views showing confluent opacities in both upper lung lobes
Fig. 12: Follow-up PA chest x-ray performed one month after the beginning of treatment showing incomplete regression of confluent opacities in both upper lung fields