Chest ultrasound compared to chest X‐ray for pediatric pulmonary tuberculosis

Abstract

IntroductionChest ultrasound is increasingly used to radiologically diagnose childhood pneumonia, but there are limited data on its use for pulmonary tuberculosis (PTB).AimCompare chest ultrasound with a chest X‐ray (CXR) findings.MethodsChildren (up to 13 years) with suspected PTB were enrolled. Bedside chest ultrasound findings were compared to CXR. The analysis was stratified by PTB category: confirmed PTB (microbiologically confirmed), unconfirmed PTB (clinical diagnosis with negative microbiological tests), or unlikely PTB (other respiratory diseases with improvement without tuberculosis treatment).ResultsOne hundred fifty‐nine children were enrolled (57% boys, median age 26.6 months [interquartile range 15.1‐59.3]). Ultrasound detected abnormalities in 72% (n = 114), CXR in 56% (n = 89), P < .001. Pleural effusion was detected on ultrasound in 15% (n = 24) compared 9% (n = 14) on CXR, P = .004, more in confirmed PTB (33%, n = 12 vs 8%, n = 4 unlikely PTB, P = .013). Ultrasound detected enlarged mediastinal lymph nodes more commonly (22%, n = 25) than CXR (6%, n = 10, P = .001); the size of lymph nodes in the unlikely category (1.0 cm) was smaller than the other two PTB categories (1.4 and 1.5 cm, P = .001). Inter‐reader agreement (kappa Cohen) was higher for ultrasound than CXR for several findings (consolidation 0.67 vs 0.47, pleural effusion 0.86 vs 0.56, enlarged lymph nodes 0.56 vs 0.27).ConclusionUltrasound detected abnormalities more frequently than CXR with the higher inter‐reader agreement; ultrasound abnormalities were most common in children with confirmed PTB. Ultrasound is a promising modality for detecting abnormalities in PTB. Further studies should evaluate the diagnostic accuracy of ultrasound against a gold standard.

Diagnostic accuracy of point-of-care ultrasound for pulmonary tuberculosis: A systematic review

“…Despite its proven utility for PTB, however, CXR hardware is expensive and the availability of CXR is limited in many high TB-burden, low-resource settings due to scarcity of both equipment and skilled radiological staff to operate and interpret the images. [9,10]. Artificial intelligence (AI)-assisted interpretation of CXRs recently obtained WHO policy recommendation [11] and may become widespread in the coming years, reducing the requirement for skilled staff, but CXR hardware cost remains a huge barrier for access [12][13][14].…”

“…By contrast, point-of-care ultrasound (POCUS) devices are inexpensive, easily portable to rural centres, do not result in exposure to ionising radiation and do not require radiological staff [9,10], making their use attractive for practical reasons in low-resource settings. The term POCUS has been used in different ways in the literature but is generally defined as an ultrasound exam performed and interpreted in real-time by a single nonradiologist operator [15][16][17].…”

Lung Ultrasound Findings Compared with Chest X-Ray Findings in Known Pulmonary Tuberculosis Patients: A Cross-Sectional Study in Lima, Peru

“…[4][5][6][7] If diagnostic accuracy of LUS for PTB is similar to that seen for pneumonia, it could play an important role in screening and diagnosis of PTB in areas without ready access to CXR. Despite the extensive literature base for LUS in pneumonia, the literature on its use for diagnosis of PTB is limited, [8][9][10][11][12] and available studies have methodological limitations including small size and lack of systematic comparison to a diagnostic imaging gold standard. This study therefore sought to systematically characterize LUS findings in adult patients with confirmed PTB and compare these LUS findings with CXR findings.…”

Pulmonary aspergilloma on transthoracic ultrasound

“…Ultrasound at the point-of-care has developed into a relatively cheap, portable and radiation-free diagnostic tool to augment physical examination, especially where resources are scarce [10]. The value of LUS is being studied for pulmonary TB as low-and middle-income countries often bear a high burden of tuberculosis (TB) and access to standard imaging may be limited [15,[18][19][20]. LUS detects features of pulmonary TB including cavitary or miliary presentation; however, the full discriminatory power of LUS to differentiate PTB from other pulmonary conditions remains to be established.…”