Authors: Savvas Andronikou Elaine Joseph Susan Lucas Stephen Brachmeyer George Du Toit Heather Zar George Swingler
Publish Date: 2004/01/06
Volume: 34, Issue: 3, Pages: 232-236
Abstract
The diagnosis of primary pulmonary tuberculosis PTB in children relies heavily on the radiographic demonstration of mediastinal lymphadenopathy Plain radiographs may be unreliable and CT is the current ‘gold standard’ for demonstrating this Only two previous studies have described the CT findings of mediastinal adenopathy exclusively in childrenOne hundred children 54 boys 46 girls with clinically suspected PTB were prospectively recruited from an overnight admission ward if they met the WHO criteria for suspected PTB CT scans were evaluated by a panel of radiologists with regard to a predetermined set of criteriaLymph nodes were present in 92 patients and nodes greater than 1 cm were present in 46 patients Enhancement of lymph nodes was present in 67 patients and was almost invariably ‘ghostlike’ ring enhancement Calcification was present in only 9 patients The most common location for lymphadenopathy was the subcarinal position n=90 followed by the hila n=85 left 74 right 72 bilateral 61 the anterior mediastinum n=79 the precarinal position n=64 and the right paratracheal position n=63 Multiple sites of involvement were present in 88 patients and a single site for lymphadenopathy subcarinal was present in only 4 patients Bronchial compression was identified in 29 patients Most commonly the left main bronchus was involved n=21 followed by the right main bronchus n=14 and the bronchus intermedius n=8 16 rightsided compressions in totalLymphadenopathy was common but only 46 patients had lymph nodes greater than 1 cm Enhancement characteristics of tuberculous adenopathy differ from that described previously Typical enhancement was ‘ghostlike’ rather than discreet ring enhancing with a lowdensity centre The site most frequently involved by nodes also differs from previous studies The subcarinal region should be the site receiving most attention for the identification of lymphadenopathy as this is most frequently involved and is also the site of the largest lymphnode masses The presence of lymphnode groups at other recognised sites adds confidence when there is doubt as multifocal involvement is common Approximately onequarter of patients with hilar adenopathy may have bronchial compression in childhood
Keywords: