Chest ultrasound findings in children with confirmed pulmonary tuberculosis in low tuberculosis incidence country

Buonsenso, Danilo; Curatola, Antonietta; Valentini, Piero; Scialanga, Barbara; Tomà, Paolo; Musolino, Anna Maria

doi:10.1002/ppul.24362

Cited by 10 publications

(10 citation statements)

References 5 publications

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“…A new technique is represented by lung ultrasound (LUS): a score system that combines X-ray and LUS will probably be validated in the near future. Some pediatric studies clarified the accuracy of LUS in bacterial pneumonia (13), while its role in pediatric TB is still under evaluation (14,15).…”

Section: Discussionmentioning

confidence: 99%

Chest CT Scan for the Diagnosis of Pediatric Pulmonary TB: Radiological Findings and Its Diagnostic Significance

et al. 2021

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Diagnosing active TB in children remains a clinical challenge, due to difficulties in achieving a definite microbiological confirmation, aspecific clinical manifestation, low sensitivity of chest radiography (CXR). For this reason, the use of chest computed tomography (CT) scan to evaluate suspected TB pediatric cases is increasing. We retrospectively reviewed records of patients aged <16 years diagnosed with active TB at the Pediatric Infectious Disease Unit of the Catholic University of the Sacred Heart to describe CT findings and to evaluate the need for its execution for diagnosis. In 41 cases, 7 CXR were normal (17.1%) while no CT scan was evaluated as negative. In 19 cases (46.3%), CXR was considered non-probable TB pulmonary, compared with 11 of 37 cases (29.7%) of CT. In 15 cases (36.6%) CXR was described as probable for TB pulmonary, instead 26 of the 37 cases evaluated by CT (70.3%) were classified as probable TB. We describe CT findings in patients with pediatric TB. We confirmed that CT can improve the diagnostic accuracy. In particular, the comparison between the CT and CXR ability in detecting cases of pulmonary TB in accordance with the proposed radiological probability criteria, showed a superiority of CT in detecting probable TB pictures (70.3%) compared with 36.6% of the x-Ray.

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Section: Discussionmentioning

confidence: 99%

Chest CT Scan for the Diagnosis of Pediatric Pulmonary TB: Radiological Findings and Its Diagnostic Significance

et al. 2021

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“…First, pediatric chests are easily evaluable with high-resolution linear probes (we used 12 mHz) due to their smaller sizes (having less muscles and fat); thus, the detection of the lung point is more easily obtained for pediatric chests than for adult chests. Second, our team is composed of pediatricians highly skilled and experienced in LUS (9)(10)(11)(12)(13). In fact, although current literature suggests that a 2-h training is sufficient to accurately train emergency physicians in detecting PNX, we think that such data are quite optimistic and can lead to wrong LUS examination (21).…”

Section: Discussionmentioning

confidence: 99%

Lung Ultrasound to Detect Pneumothorax in Children Evaluated for Acute Chest Pain in the Emergency Department: An Observational Pilot Study

et al. 2022

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BackgroundSpontaneous pneumothorax is a relatively uncommon and poorly studied condition in children. While several protocols have been developed to evaluate the use of lung ultrasound for dyspneic adult patients in the emergency department, no specific guidelines are present for pediatric emergency physicians.ObjectivesWe prospectively analyzed children with acute chest pain and clinical suspicion of pneumothorax evaluated at the pediatric emergency department.MethodsWe consecutively enrolled children aged 5–17 years presenting to the pediatric emergency department with clinically suspected pneumothorax based on sudden onset of acute chest pain. After clinical examination, all children underwent lung ultrasound followed by chest X-ray (reference standard). We enrolled 77 children, of which 13 (16.9%) received a final diagnosis of pneumothorax.ResultsThe lung point had a sensitivity of 92.3% (95% CI 77.8–100) and a specificity of 100% (95% CI 94.4–100) for the detection of pneumothorax. The “barcode sign” had a sensitivity of 100% (95% CI 75.3–100) and a specificity of 100% (95% CI 94.4–100) for the detection of pneumothorax.ConclusionLung ultrasound is highly accurate in detecting or excluding pneumothorax in children with acute chest pain evaluated in the pediatric emergency department. If pneumothorax is suspected, but the lung point is not visible, the barcode sign should always be sought as it could be a form of massive pneumothorax.

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“…Ultrasound is an attractive technique to diagnose pulmonary disease in children particularly because it does not expose the child to ionizing radiation and does not require sedation. Recent studies have explored the potential usefulness of ultrasound for pediatric TB but the application was still limited 55 …”

Section: Discussionmentioning

confidence: 99%

Comparison of pediatric empyema secondary to tuberculosis or non‐tuberculosis community‐acquired pneumonia in those who underwent surgery in high TB burden areas

Yang

Chen

et al. 2021

Pediatric Pulmonology

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Introduction Tuberculous empyema (TE) in children is common in high‐TB burden and medical resource‐limited areas. However, studies that evaluate the characteristics of TE in children are sparse. This study aimed to analyze the clinical features of pediatric TE receiving surgical intervention. Methods We performed a retrospective study of children with empyema secondary to community‐acquired pneumonia who underwent surgery in our institution. The clinical characteristics were compared between TE and empyema secondary non‐tuberculosis infection (non‐tuberculosis empyema, NTE). Results One hundred patients were included (27 with TE and 73 with NTE). Stage 3 empyema occupied 81.5% and 45.2% of TE and NTE in this study. The TE children had older age, longer duration of illness, and milder symptoms. Pleural fluid culture was positive for Mycobacterium tuberculosis in 7.4% of patients with TE. Lymph node enlargement, lymph node calcification, and pleural nodules presented in TE with high specificity (93.2%, 98.6%, and 98.5%) but low sensitivity (33.3%, 14.8%, and 29.6%) on CT scan. Thoracoscopy surgery was performed in 14 (51.9%) in TE and 39 (53.4%) in NTE. Postoperative chest‐tube indwelling time was longer (7.85 ± 5.00 vs. 4.89 ± 1.81 days, p < .001), and more patients had incomplete lung expansion after 3 months in TE. Conclusion Tuberculosis infection should be screened in management of children with empyema in high‐TB burden areas. Pediatric TE usually presented at older age and with milder respiratory symptoms. Pleural biopsy during surgery is often necessary to confirm the cause of infection. Thoracotomy is still required in some pediatric TE or NTE with delayed treatment in medical resource‐limited area.

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Chest ultrasound findings in children with confirmed pulmonary tuberculosis in low tuberculosis incidence country

Cited by 10 publications

References 5 publications

Chest CT Scan for the Diagnosis of Pediatric Pulmonary TB: Radiological Findings and Its Diagnostic Significance

Chest CT Scan for the Diagnosis of Pediatric Pulmonary TB: Radiological Findings and Its Diagnostic Significance

Lung Ultrasound to Detect Pneumothorax in Children Evaluated for Acute Chest Pain in the Emergency Department: An Observational Pilot Study

Comparison of pediatric empyema secondary to tuberculosis or non‐tuberculosis community‐acquired pneumonia in those who underwent surgery in high TB burden areas

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