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Pulmonary Tuberculosis in Infants: Radiographic and CT Findings

¹ Department of Radiology, Seoul National University College of Medicine Institute of Radiation Medicine, SNUMRC (Seoul National University Medical Research Center), Seoul, Korea.
² Present address: Department of Radiology, National Cancer Center, 809 Madu-I-dong, Islan dong-gu, Goyang-si, Gryeonggi-do, Korea.
³ Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.

Received May 11, 2004; accepted after revision June 7, 2005.

 
Address correspondence to J.-I. Choi (dumkycji{at}hanmail.net).

Abstract

Top Abstract Introduction Materials and Methods Results Discussion References

 
OBJECTIVE. As complications of tuberculosis are frequent in infancy, correct diagnosis of tuberculosis in infants is important. The purposes of this study are to summarize radiographic and CT findings of pulmonary tuberculosis in infants and to determine the radiologic features frequently seen in infants with this disease.

CONCLUSION. Frequent radiologic findings of pulmonary tuberculosis in infants are mediastinal or hilar lymphadenopathy with central necrosis and air-space consolidations, especially masslike consolidations with low-attenuation areas or cavities within the consolidation. Disseminated pulmonary nodules and airway complications are also frequently detected in this age group. CT is a useful diagnostic technique in infants with tuberculosis because it can show parenchymal lesions and tuberculous lymphadenopathy better than chest radiography. CT scans can also be helpful when chest radiographs are inconclusive or complications of tuberculosis are suspected.

Keywords: chest • CT • infant/neonate • primary tuberculosis • chest radiography • tuberculosis

Introduction

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Tuberculosis remains an important cause of morbidity and mortality worldwide. Mainly as a result of the worsening HIV epidemic, homelessness, drug abuse, and immigration from developing countries, the problem of pulmonary tuberculosis in Western countries has markedly increased [1-4]. Children represent one of the high-risk groups in the resurgence of this disease [5-7]. Among children, those younger than 5 years are at the highest risk for pulmonary tuberculosis [2].

Pulmonary tuberculosis in infants has some differences from that seen in older children; it is more symptomatic, and the risk of severe and life-threatening complications such as tuberculous meningitis or miliary tuberculosis is higher [7-9]. Therefore, early diagnosis and prompt treatment are very important for infants with tuberculosis. Bacteriologic confirmation of the disease in children is difficult [5, 10, 11], and in younger infants (< 3 months), the tuberculin skin test is frequently negative [8-11]. Therefore, chest radiographs and a history of direct contact with patients who have contagious tuberculosis play essential roles in diagnosing tuberculosis in infants. The importance of the role of radiologists cannot be overemphasized.

CT scans have advantages over conventional radiographs in diagnosing tuberculosis in pediatric patients and can detect the disease in patients whose chest radiographs are normal or equivocal. CT scans can reveal lymphadenopathy; calcifications; bronchogenic nodules; and complications such as airway narrowing, emphysema, and pleural effusion [12-17]. High-resolution CT may depict miliary nodules or bronchogenic nodules in the lung parenchyma, especially in patients with no evidence of nodules on the chest radiograph [17, 18]. Although a few studies have reported chest radiographic findings of infant tuberculosis [7-9], CT findings of the disease have been reported only sporadically [16, 19]. The purposes of this study are to summarize radiographic and CT findings of pulmonary tuberculosis in infants and identify the frequent radiologic findings of pulmonary tuberculosis in infants.

Materials and Methods

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We retrospectively reviewed chest radiographs (n = 25) and chest CT scans (n = 17) of 25 consecutive infants who were diagnosed with pulmonary tuberculosis in our institution from 1991 to 2003. The diagnosis of tuberculosis was established by positive culture or staining of gastric aspirates for acid-fast bacilli in four patients, positive results of polymerase chain reaction for Mycobacterium tuberculosis in five patients, positive culture of ascites for M. tuberculosis in one, and surgical biopsy in one. In the remaining 14 patients, more than two of the following three criteria were met [20]: tuberculin skin test (Mantoux test) with five tuberculin units of purified protein derivative that resulted in an area of induration of 10 mm or greater; ruling out other causes of disease and finding that subsequent clinical course of the disease was consistent with tuberculosis (clinical or radiologic improvement from antituberculous medications); and discovery of at least one family member with contagious tuberculosis.

View larger version (157K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —4-month-old girl with pulmonary tuberculosis (patient 15). Masslike consolidation and bronchial obstruction caused by hilar lymphadenopathy. Chest radiograph shows consolidation in right lower lung zone (asterisk) and widening of right upper mediastinum (arrows).

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —4-month-old girl with pulmonary tuberculosis (patient 15). Masslike consolidation and bronchial obstruction caused by hilar lymphadenopathy. Enhanced CT scan shows well-defined, well-enhancing, masslike consolidation in right lower lobe (asterisk). Note low-attenuation lymphadenopathy (arrow) obstructing bronchus intermedius.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —4-month-old girl with pulmonary tuberculosis (patient 15). Masslike consolidation and bronchial obstruction caused by hilar lymphadenopathy. CT scan in lower level of image seen in B shows large consolidation in right middle lobe and right lower lobe. Consolidation is slightly volume expanding. There are multiple low-attenuation areas (arrows) in consolidation area.

Initial chest radiographs were available in all patients. Follow-up chest radiographs were available in 23 patients. The radiographic follow-up was not uniform in all patients, and the mean follow-up duration was 2 years (range, 4 months to 3.5 years).

Chest CT scans were performed 1-10 days (mean, 4 days) after initial chest radiography for one or more of the following reasons: to evaluate unusual findings on radiographs such as masslike lesions or widespread nodules; to find or confirm lymphadenopathy; and to detect or evaluate complications such as airway narrowing with or without atelectasis or emphysema, or pleural or pericardial tuberculosis.

View larger version (97K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —6-month-old boy with pulmonary tuberculosis (patient 10). Large cavity within consolidation. Chest radiograph shows large cavity within consolidation in right upper lobe (arrow). Multiple nodules are seen in left upper lung field (arrowheads).

Three radiologists analyzed the chest radiographs and CT scans by consensus. In the chest radiographs, particular attention was given to the pattern of pulmonary parenchymal lesions (consolidation, nodules, and disseminated disease), cavities within parenchymal lesions, mediastinal bulging suggesting lymphadenopathy, and airway or pleural complications. On the CT scans, patterns of pulmonary parenchymal lesions (airspace consolidation, bronchogenic nodules, and disseminated nodules); cavities within parenchymal lesions; mediastinal and hilar lymphadenopathy with or without central necrosis; airway complications; pleural, pericardial, and chest wall lesions; and involvement of other organs were observed carefully. When we found a consolidation during the reviewing process, which was enhancing well after contrast agent administration, was volume preserving or expanding, and had no air-bronchogram within it, we defined it as a "masslike consolidation."

Results

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Chest Radiography
On chest radiography (n = 25), air-space consolidation was the most common parenchymal lesion, occurring in 20 patients (80%) (Fig. 1A). Nodular lesions were found in seven patients (28%), and, among them, ipsilateral or contralateral air-space consolidation was seen in five patients (Fig. 2). Disseminated nodules were found in six patients (24%) (Figs. 3A, 4A, and 5A), and all of them were 4 months old or younger. Cavitations within parenchymal lesions were noted in two patients (Figs. 2 and 4A).

View larger version (168K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —4-month-old girl with systemic disseminated tuberculosis (patient 12). Chest radiograph shows multiple disseminated nodules in both lungs and consolidation in left lower lung zone (asterisk).

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —4-month-old boy with acute disseminated tuberculosis (patient 14). Cavitary changes in nodules are seen. Chest radiograph shows numerous nodules in both lungs. Thin-walled cavity (arrows) is seen in left lower lobe.

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —3-month-old boy (patient 1) with acute disseminated tuberculosis. Chest radiograph shows multiple disseminated nodules with random distribution in both lungs.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —5-month-old girl (patient 2) with bronchogenic spread of tuberculosis and bronchial stenosis. Chest radiograph shows left hilar bulging (white arrow) and hyperinflation of left lung. Note narrowing of left main bronchus (black arrows).

View larger version (100K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —4-month-old girl with systemic disseminated tuberculosis (patient 12). Enhanced CT scan shows consolidation with low-attenuation area (arrows) within it in superior segment of left lower lobe.

View larger version (73K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —4-month-old girl with systemic disseminated tuberculosis (patient 12). Chest CT scan shows disseminated nodules of variable size. Most nodules are larger than 2 mm in diameter.

View larger version (109K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —4-month-old boy with acute disseminated tuberculosis (patient 14). Cavitary changes in nodules are seen. On chest CT, multiple variable-sized nodules are detected. Cavity formation in some nodules is noted (arrows).

View larger version (92K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —3-month-old boy (patient 1) with acute disseminated tuberculosis. Chest CT scan shows multiple small nodules in both lungs.

View larger version (105K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —5-month-old girl (patient 2) with bronchogenic spread of tuberculosis and bronchial stenosis. High-resolution CT scan reveals peribronchial infiltrations and peripheral small nodules (arrows) suggesting bronchogenic spread of tuberculosis in left upper lobe. Hyperinflation of left lung is also noted.

View larger version (69K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —5-month-old girl (patient 2) with bronchogenic spread of tuberculosis and bronchial stenosis. CT scan shows narrowing of left main bronchus (black arrows) by enlarged subcarinal lymph nodes (white arrow).

View larger version (69K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6D —5-month-old girl (patient 2) with bronchogenic spread of tuberculosis and bronchial stenosis. Segmental bronchi (white arrow) of left upper lobe are also stenosed by hilar lymph nodes (asterisk). Note enlarged subcarinal lymph node with central low attenuation (black arrows).

Chest radiography and CT findings are summarized in Table 1.

Additional Information at CT
In all 17 patients who had a CT scan, we acquired additional information that could not be obtained at chest radiography: revelation of mediastinal lymphadenopathy (n = 4), confirmation of lymphadenopathy (n = 13), depiction of central necrosis (n = 17) or calcification (n = 2) within the enlarged lymph nodes, detection of bronchial stenosis distal to the lobar bronchus (n = 7), revelation of pleural involvement (n = 4) and pericardial thickening (n = 2), and detection of extrathoracic lesions (n = 3). In four patients (24%), a diagnosis of tuberculosis was suggested only after a CT scan revealed enlarged lymph nodes with central necrosis (Table 1). Extrathoracic involvement (liver [n = 2], spleen [n = 3], and kidney [n = 1]) of tuberculosis was revealed in the chest CT scan in three patients with disseminated pulmonary nodules (Fig. 3D).

View larger version (90K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —4-month-old girl with systemic disseminated tuberculosis (patient 12). Numerous low-attenuation nodules are noted in spleen on enhanced CT scan.

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —4-month-old boy with acute disseminated tuberculosis (patient 14). Cavitary changes in nodules are seen. Follow-up chest radiograph obtained 1 year after A and B shows no parenchymal nodule in either lung.

View larger version (158K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —3-month-old boy (patient 1) with acute disseminated tuberculosis. On follow-up chest radiograph obtained after antituberculosis medication for 1 year, nodules are healed, leaving multiple calcifications. Note multiple calcifications in spleen (arrows).

Discussion

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Most pulmonary tuberculosis cases seen in infants are primary tuberculosis. The primary infection begins with deposition of infected droplets in the lung alveoli, followed by parenchymal inflammation [11, 21]. The initial inflammation produces localized alveolar consolidation, which is the primary focus. This may, although rarely, progress to involve a segment or an entire lobe and usually is not visible on chest radiographs [21, 22]. Infection then spreads to the central lymph nodes from the primary focus via draining lymphatic vessels (appearing as a linear interstitial pattern on chest radiographs) and results in regional lymphadenopathy. Together, the primary focus and the enlarged lymph nodes that drain it are called the Ranke complex [21-24]. In most cases, the mild parenchymal lesions and lymphadenopathy resolve spontaneously. In some cases, however, especially in young infants, the involved lymph nodes continue to enlarge [11]. Caseation necrosis of the regional lymph nodes progresses, and the enlarged nodes may compress the regional bronchi and cause bronchial narrowing, obstruction, and emphysema [21, 22]. As disease progresses, inflamed nodes can perforate neighboring bronchus and discharge caseous material into the bronchial tree, causing bronchogenic tuberculosis and focal or lobar pneumonia [25, 26].

Mediastinal lymphadenopathy with or without parenchymal abnormality is a radiologic hallmark of primary tuberculosis in childhood [20-24]. In our study, chest radiography showed mediastinal lymphadenopathy and parenchymal abnormality in 72% and 96% of patients, respectively, and the most frequent radiographic finding of pulmonary parenchymal lesions was consolidation (80%). Leung et al. [20], in their series of 191 children, reported age-related differences in the prevalence of parenchymal abnormalities. Children 0-3 years old had a higher prevalence of lymphadenopathy (100%) and a lower prevalence of parenchymal abnormalities (51%) compared with those 4-15 years old. In their series, lymphadenopathy as the only radiologic manifestation of primary pulmonary tuberculosis was a feature of early childhood, occurring in 49% of cases; only 9% of patients in later childhood or adolescence showed such findings. However, in our study, most patients revealed parenchymal changes in conjunction with lymphadenopathy, and isolated mediastinal lymphadenopathy without parenchymal abnormality was rarely seen. In this study, chest radiography showed disseminated pulmonary tuberculosis in six patients (24%). All of them were 4 months of age or younger. Disseminated nodules were seen in the spleen (n = 2) or liver (n = 1) in CT scans of two patients with disseminated pulmonary tuberculosis (patients 3 and 12). Diffuse enlargement of the liver, spleen, and kidney was noted in one patient (patient 1) at CT scan. An MRI of the brain in one patient revealed tuberculous meningitis with disseminated tuberculomas (patient 3). In agreement with other studies [16, 17, 24], disseminated tuberculosis seemed to be more common in infants than older children.

It is well established that CT scans detect or confirm lymphadenopathy [12-15, 27]. Delacourt et al. [14], in their series of 15 children with tuberculous infection and negative chest radiography, found enlarged lymph nodes in 60% of patients on chest CT. On enhanced CT scans, tuberculous lymphadenopathy is seen as enlarged nodes with low-attenuation centers because of caseation necrosis and peripheral rim enhancement representing inflammatory hypervascularity [13, 27, 28]. In our study, CT scans delineated lymphadenopathy in four patients who were not suspected to have lymphadenopathy on chest radiographs. Therefore, CT scans can be helpful in diagnosing tuberculosis when findings of chest radiographs are inconclusive.

In our study, air-space consolidation was the most common of parenchymal lesions seen on CT scans (100%), which was more common than that reported in the literature for childhood cases (19% [12] and 49% [13]). In this study, we frequently found masslike consolidation, which was well enhancing, volume preserving or expanding, and had no air bronchogram within it. As mentioned previously, enlarged hilar lymph nodes can compress neighboring regional bronchus and cause diffuse inflammation of the bronchus [21-23]. The common sequence is hilar lymphadenopathy, followed by atelectasis and consolidation [11]. The resulting radiographic findings have been called "collapse-consolidation," "segmental lesions," and "epituberculosis" [11, 22]. We believe the same disease process described as collapse-consolidation can explain masslike consolidation on CT scans in our study. Collapse-consolidation is more common in infants than older children and tends to occur within months of the initial infection [11]. Although masslike consolidation was found in 59% of the patients with consolidation on CT scans in our series, it was found in only 15% of patients in the study by Kim et al. [13] of childhood tuberculosis.

Low-attenuation areas within the consolidation, representing caseating necrosis, were also more common in our study, at 41%, than in that of Kim et al. [13], at 25%. Cavitations within consolidations were found in 29% of patients in our series. Cavitation, indicating high infectivity and high bacillary burden, is the hallmark radiographic findings in postprimary tuberculosis [21, 29], and it is rare in children with primary tuberculosis [11, 19-21]. Cavitation was frequently associated with low-attenuation areas within consolidations (3/5, 60%) in our study. Bullous or cystic lesions in the lung can develop as a rare complication. Necrosis and liquefaction in areas of pneumonic consolidation are thought to be the cause of extensive bullous lesions [30, 31]. In our study, one patient developed an extensive bullous lesion.

It is well established that CT scans have advantages over chest radiographs for detecting the brochogenic spread of tuberculosis [32] and miliary tuberculosis [16-18]. Although bronchogenic nodules were seen in only 29% of patients with childhood tuberculosis [13], they were found in 41% of patients in our study. Jamieson and Cremin [17] reviewed high-resolution CT findings of pulmonary tuberculosis in six young children with multiple disseminated nodules on chest radiographs. In their study, disseminated nodules varied in size and were even or irregular in distribution. They suggested using the term "acute disseminated tuberculosis" rather than "miliary tuberculosis" for pediatric patients because miliary nodules are defined as tiny nodules less than 2 mm in diameter, uniform in size, and widespread in distribution [33]. On CT scans in our study, disseminated nodules were seen in 29% of the patients. Nodules were larger (> 2 mm) than usual miliary nodules and coalesced with each other in three of five patients.

Infant airways are smaller and more easily compressed by enlarged hilar lymph nodes [8, 11, 34]. In our study, bronchial narrowing was seen in 65% and hyperinflation of lung parenchyma was seen in 47% of patients on CT scans. These airway complications were more common than those of childhood tuberculosis (bronchial narrowing in 37% [13] and 29% [27]). CT scans detect airway complications better than chest radiographs [34]. In seven of 11 patients with bronchial narrowing, we observed bronchial narrowing distal to the lobar bronchus on CT scans that was not seen on the chest radiographs.

Pleural effusion in primary tuberculosis results from pleural infection via direct extension—rupture of a subpleural lesion into the pleural space or spread from caseous lymphadenopathy or an adjacent spinal lesion [35]. Pleural effusion is not a common feature of primary pulmonary tuberculosis in young children, and it is rare in infants [8, 20]. In pleural tuberculosis, CT scans are also helpful for determining whether the thickening seen on chest radiographs represents pleural thickening; chronic loculated effusion, which usually needs decortication; or empyema [35]. Table 3 summarizes the previously reported radiographic and CT findings of infant and childhood primary pulmonary tuberculosis compared with our results.

Early diagnosis and prompt treatment, considering their duration of symptoms (< 1 week), was possible in only four patients in our study: three patients who showed definite mediastinal bulging on initial chest radiographs and had a positive Mantoux test, and one patient who showed miliary dissemination of tuberculosis at chest radiography and had a history of recent contact with active tuberculosis.

Radiographic regression of primary pulmonary tuberculosis is a slow process. In our study, complete resolution of the consolidation occurred after a maximum of 6 months of treatment, and improvement of the air-space consolidation preceded regression of enlarged nodes. Follow-up radiography after antituberculous medication may be performed to be sure that no progression or complications have occurred. It is not always necessary to achieve normal chest radiography to discontinue treatment [20, 36].

In summary, frequent radiologic findings of pulmonary tuberculosis of infants are mediastinal or hilar lymphadenopathy with central necrosis and air-space consolidations, especially masslike consolidations with low-attenuation areas or cavities within consolidations. Disseminated pulmonary nodules and airway complications are also frequently detected in this age group. CT can be a useful diagnostic technique for infant tuberculosis, as it can show parenchymal lesions and tuberculous lymphadenopathy better than chest radiography. CT scans can also be helpful when chest radiographs are inconclusive or complications of tuberculosis are suspected.

References

Top Abstract Introduction Materials and Methods Results Discussion References

 

1. Schneider E, Castro KG. Tuberculosis trends in the United States, 1992-2001. Tuberculosis (Edinb) 2003;83 : 21-29
2. Buckner CB, Leithiser RE, Walker CW, Allison JW. The changing epidemiology of tuberculosis and other mycobacterial infections in the United States: implications for the radiologists. AJR1991; 156:255 -264[Abstract/Free Full Text]
3. FitzGerald JM, Grzybowski S, Allen EA. The impact of human immunodeficiency virus infection on tuberculosis and its control. Chest 1991; 100:191 -200[Free Full Text]
4. Cremin BJ. Tuberculosis: the resurgence of our most lethal infectious disease—a review. Pediatr Radiol1995; 25:620 -626[Medline]
5. Burroughs M, Beitel A, Kawamura A, et al. Clinical presentation of tuberculosis in culture-positive children. Pediatr Infect Dis J 1999; 18:440 -446[CrossRef][Medline]
6. Stark JR, Jacobs RF, Jereb J. Resurgence of tuberculosis in children. J Pediatr 1992;120 : 839-855[CrossRef][Medline]
7. Amodio J, Abramson S, Berdon W. Primary pulmonary tuberculosis in infancy: a resurgent disease in the urban United States. Pediatr Radiol 1986; 16:185 -189[CrossRef][Medline]
8. Schaaf HS, Gie RP, Beyers N, Smuts N, Donald PR. Tuberculosis in infants less than 3 months of age. Arch Dis Child1993; 69:371 -374[Abstract/Free Full Text]
9. Vallejo JG, Ong LT, Starke JR. Clinical features, diagnosis, and treatment of tuberculosis in infants. Pediatrics1994; 94:1 -7[Abstract/Free Full Text]
10. Shingadia D, Novelli V. Diagnosis and treatment of tuberculosis in children. Lancet Infect Dis 2003;3 : 624-632[CrossRef][Medline]
11. Agrons GA, WMarkowitz RI, Kramer SS. Pulmonary tuberculosis in children. Semin Roentgenol 1993;28 : 158-172[Medline]
12. Uzum K, Karahan OI, Dogan S, Coskun A, Topcu F. Chest radiography and thoracic computed tomography findings in children who have family members with active pulmonary tuberculosis. Eur J Radiol2003; 48:258 -262[CrossRef][Medline]
13. Kim WS, Moon WK, Kim IO, et al. Pulmonary tuberculosis in children: evaluation with CT. AJR 1997;168 : 1005-1009[Abstract/Free Full Text]
14. Delacourt C, Mani TM, Bonnerot V, et al. Computed tomography with normal chest radiograph in tuberculous infection. Arch Dis Child 1993; 69:430 -432[Abstract/Free Full Text]
15. Bosch-Marcet J, Serres-Creixams X, Zuasnabar-Cotro A, Codina-Puig X, Catala-Puigbo M, Simon-Riazuelo JL. Comparison of ultrasound with plain radiography and CT for the detection of mediastinal lymphadenopathy in children with tuberculosis. Pediatr Radiol2004; 34:895 -900[CrossRef][Medline]
16. Kim KI, Lee JW, Park JH, et al. Pulmonary tuberculosis in five young infants with nursery exposure: clinical, radiographic and CT findings. Pediatr Radiol 1998;28 : 836-840[CrossRef][Medline]
17. Jamieson DH, Cremin BJ. High resolution CT of the lungs in acute disseminated tuberculosis and a pediatric radiology perspective of the term "miliary." Pediatr Radiol1993; 23:380 -383[CrossRef][Medline]
18. Oh YW, Kim YH, Lee NJ, et al. High-resolution CT appearance of miliary tuberculosis. J Comput Assist Tomogr1994; 18:862 -886[Medline]
19. Van Hest R, De Vries G, Morbano G, Pijnenburg M, Hartwig N, Baars H. Cavitating tuberculosis in an infant: case report and literature review. Pediatr Infect Dis J 2004;23 : 667-670[Medline]
20. Leung AN, Müller NL, Pineda PR, FitzGerald JM. Primary tuberculosis in childhood: radiographic manifestations. Radiology 1992;182 : 87-91[Abstract/Free Full Text]
21. Effmann EL. Pulmonary infection. In: Kuhn JP, Slovis TL, Haller JO, eds. Caffey's pediatric diagnostic imaging, 10th ed. Philadelphia, PA: Mosby, 2004:982 -1039
22. McAdams HP, Erasmus J, Winter JA. Radiologic manifestations of pulmonary tuberculosis. Radiol Clin North Am1995; 33:655 -678[Medline]
23. Marais BJ, Gie RP, Schaaf HS, et al. A proposed radiological classification of childhood intra-thoracic tuberculosis. Pediatr Radiol 2004; 34:886 -894[CrossRef][Medline]
24. Lamont AC, Cremin BJ, Pelteret RM. Radiological patterns of pulmonary tuberculosis in the paediatiric age group. Pediatr Radiol 1986; 16:2 -7[CrossRef][Medline]
25. Lorriman G, Bentley FJ. The incidence of segmental lesions in primary tuberculosis in childhood. Am Rev Tuberc1959; 79:756 -763[Medline]
26. Morrison JB. Natural history of segmental lesions in primary pulmonary tuberculosis. Arch Dis Child1973; 48:90 -98[Free Full Text]
27. Andronikou S, Joseph E, Lucas S, et al. CT scanning for the detection of tuberculous mediastinal and hilar lymphadenopathy in children. Pediatr Radiol 2004;34 : 232-236[CrossRef][Medline]
28. Im JG, Song KS, Kang HS, et al. Mediastinal tuberculous lymphadenitis: CT manifestations. Radiology1987; 164:115 -119[Abstract/Free Full Text]
29. Shewchuk JR, Reed MH. Pediatric postprimary pulmonary tuberculosis. Pediatr Radiol 2002;32 : 648-651[CrossRef][Medline]
30. Matsaniotis N, Kattamis C, Economou-Mavrou C, Kyriazakou M. Bullous emphysema in childhood tuberculosis. J Pediatr1967; 71:703 -707[CrossRef][Medline]
31. Harris VJ, Schauf V, Duda F, White H. Fatal tuberculosis in young children. Pediatrics 1979;63 : 912-914[Abstract/Free Full Text]
32. Im JG, Itoh H, Shim YS, et al. Pulmonary tuberculosis: CT findings—early active disease and sequential changes with antituberculous therapy. Radiology 1993;186 : 653-660[Abstract/Free Full Text]
33. Tuddenham WJ. Glossary of terms of thoracic radiology: recommendations of the Nomenclature Committee of the Fleischner Society. AJR 1984; 143:509 -517[Free Full Text]
34. Choe KO, Jeong HJ, Sohn HY. Tuberculous bronchial stenosis: CT findings in 28 cases. AJR 1990;155 : 971-976[Abstract/Free Full Text]
35. Hulnick DH, Naidich DP, McCauley DI. Pleural tuberculosis evaluated by computed tomography. Radiology 1983;149 : 759-765[Abstract/Free Full Text]
36. Correa AG. Unique aspects of tuberculosis in the pediatric population. Clin Chest Med 1997;18 : 89-98[CrossRef][Medline]

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This Article Abstract Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kim, W. S. Articles by Lee, H. J. Search for Related Content PubMed PubMed Citation Articles by Kim, W. S. Articles by Lee, H. J. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?