The Spectrum of Radiographic Appearances of Pulmonary Tuberculosis in Children

Abstract

Introduction: The Pediatric pulmonary tuberculosis (PTB) is diagnostically challenging because of nonspecific clinical manifestations, paucibacillary disease, and difficulties in obtaining microbiological confirmation. The Radiological imaging plays an important role in identifying the diverse manifestations of PTB.

Aim & Objective: This study aimed to describe the spectrum of radiographic appearances of pulmonary tuberculosis in children and compare chest radiography (CXR) with computed tomography (CT).

Material & Methods: This prospective observational study was conducted in the Department of Radiodiagnosis, G.R. Medical College, Gwalior, from April 2023 to March 2025. Fifty-five children aged 2 months to 18 years with suspected or confirmed pulmonary tuberculosis were included. Patients underwent digital CXR and HRCT chest according to clinical requirements. Demographic, clinical, radiographic, and CT findings were recorded and analyzed.

Results: Of 55 patients, 54.55% were males and 45.45% females, with the 12–18-year age group predominating (43.64%). Persistent cough was the commonest clinical presentation (50.91%), followed by chronic fever (40%). On CXR, inhomogeneous opacities were most frequent (30.9%), followed by cavities and bulky hilum (18.2% each), pleural effusion (14.5%), and miliary tuberculosis (7.3%). HRCT demonstrated cavities in 58.2%, mediastinal lymphadenopathy in 43.6%, consolidation in 25.5%, centrilobular nodular/tree-in-bud opacities in 23.6%, pleural effusion in 10.9%, and miliary tuberculosis in 9.1%. Final diagnoses included primary TB (60%), pleural effusion (12.73%), and miliary TB (18.18%).

Conclusion: The Pediatric PTB demonstrates a broad spectrum of radiological manifestations. The HRCT provides greater visualization of parenchymal lesions, cavities, fibrosis, endobronchial communication, and mediastinal lymphadenopathy than CXR. CT should therefore be considered when the radiographic findings are inconclusive or complications are suspected.

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