JOURNAL READING

Standardized radiographic interpretation of

thoracic tuberculosis in children
Disusun oleh: Listiana Widyarahma
Pembimbing : dr. Komala Dewi, Sp.Rad
 ABSTRACT

In this article we promote a standardized approach in clinical and

radiographic classification for children suspected of having or
diagnosed with childhood tuberculosis. We propose standardized
terms to diminish confusion and miscommunication, which can affect
management. In addition, we present pitfalls and limitations of imaging.

Keywords: Children, Computed tomography, Ghon focus, Progressive

primarytuberculosis, Radiography, Tuberculosis.

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 INTRODUCTIONS

Generally the pathological changes in childhood tuberculosis are pauci-

bacillary, and thus the diagnosis of intrathoracic tuberculosis depends largely
on chest imaging

[1]. Pulmonary tuberculosis has been classically classified

as primary tuberculosis in children and post-primary tuberculosis in adults.

[2]. However, because of the changing epidemiology there is a considerable

overlap in the radiologic presentations of these entities [2].
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Clinical categories for intrathoracic tuberculosis in children:

Persistent Cough

Weight loss / failure to thrive

Persistent unexplained fever

Persistent, unexplained lethargy

or reduced activity

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Confirm Tuberculosis:
The culture from a specimen
representative of intrathoracic disease
(e.g., sputum, nasopharyngeal/gastric
aspirate, pleural fluid) is positive
Xpert MTB/RIF — a rapid test to
simultaneously detect Mycobacterium
tuberculosis and resistance to
rifampicin — from any specimen is
positive.
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The Xpert MTB/RIF is not only
sensitive and specific for
diagnosing pediatric pulmonary
mycobacterial tuberculosis but is
also effective in detecting
rifampicin resistance
WHO 2013 strongly recommended
Xpert MTB/RIF for use rather than
conventional microscopy, culture and
drug-susceptibility testing as the initial
diagnostic test in children suspected
of having multidrugresistant-
tuberculosis or human
immunodeficiency virus (HIV)-
associated tuberculosis
 Probable Tuberculosis: Possible Tuberculosis:

1. Positive clinicals response

to anti-tuberculosis theraphy. 1. Unlikely Tuberculosis

2. Positive tuberculine skin test or

2. Tuberculosis Exposed
interferon gamma release assay
3. Tuberculous Infection
3. Documented exposure/close
contact with a known tuberculosis
patient
4. Tuberculous Disease

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PRIMARY TUBERCULOSIS

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 MILIARY TUBERCULOSIS

Vestibulum congue Vestibulum congue Vestibulum congue

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LYMPHOBRONCHIAL/LYMPHOTRACHEOB
RONCHIAL TUBERCULOSIS

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PLEURAL TUBERCULOUS DISEASE

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PERICARDIAL DISEASE

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POST-PRIMARY TUBERCULOSIS

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