Utility and Limits of Lung Ultrasound in Childhood Pulmonary Tuberculosis: Lessons from a Case Series and Literature Review

Abstract

Childhood pulmonary tuberculosis (PTB) diagnosis is often a challenge that requires a combination of history, clinical, radiological, immunological and microbiological findings. Radiological diagnosis is based today on the use of chest X-ray and chest CT that, in addition to being radio-invasive tools for children, are often not available in countries with low-resources. A non-invasive, easily usable and reproducible, low-cost diagnostic tool as LUS would therefore be useful to use to support the diagnosis of childhood PTB. Data on the use of LUS for the diagnosis and follow-up of childhood PTB are limited and in some respects contradictory. To help better define the potential role of LUS we have described the pros and cons of lung ultrasound method through a brief review of the studies in the literature and reporting some case series in which we describe clinical, laboratory, radiological results as well as detailed lung ultrasound findings of four children/adolescents with PTB.

TB or not TB? Diagnostic Sensitivity, Specifity and Interobserver Agreement in the Radiological Diagnosis of Pulmonary Tuberculosis in Children

“…Computer aided tools might help to improve radiological diagnosis 20 . In addition to this, MRI and ultrasound need to be considered as additional, increasingly sensitive and radiation free diagnostic tools 21 22 . In the future, additional biomarkers to distinguish more clearly between infection and disease will hopefully be applicable 23 .…”

Parenchymal Cavitations in Pulmonary Tuberculosis: Comparison between Lung Ultrasound, Chest X-ray and Computed Tomography

“…It also has to be remembered that LUS does not identify the deepest lesions that do not reach the pleural surfaces and it is an operator-dependent technique, based on the experience of the medical doctor. Another limitation is the difficulty of making a confident radiological diagnosis in the case of non-pulmonary TB in patients with similar clinical–radiological and epidemiological features; if needed, BAL or sputum analysis is fundamental in making a correct diagnosis [ 29 , 30 ]. On the other hand, our work underlines some advantages of LUS that are widely useful for radiologists and clinicians: it is widely available, is safer and cheaper compared with CT and can be easily performed in every hospital and health facility, in low- to middle-income countries as well [ 31 , 32 ].…”

The Role of Ultrasound in the Diagnosis of Pulmonary Infection Caused by Intracellular, Fungal Pathogens and Mycobacteria: A Systematic Review

“…In this context, the use of ultrasonography as an affordable point-of-care diagnostic tool is extremely attractive. Indeed, given that LUS is becoming increasingly popular its use for suspected TB cases, it has been explored by a number of studies [45,62,[93][94][95].…”