Chest ultrasound compared to chest X-ray for pediatric pulmonary tuberculosis.

Pediatr Pulmonol 2019 Sep 1. Epub 2019 Sep 1.

Department of Pediatrics and Child Health and MRC Unit on Child and Adolescent Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.

Introduction: Chest ultrasound is increasingly used to radiologically diagnose childhood pneumonia, but there are limited data on its use for pulmonary tuberculosis (PTB).

Aim: Compare chest ultrasound with a chest X-ray (CXR) findings.

Methods: Children (up to 13 years) with suspected PTB were enrolled. Bedside chest ultrasound findings were compared to CXR. The analysis was stratified by PTB category: confirmed PTB (microbiologically confirmed), unconfirmed PTB (clinical diagnosis with negative microbiological tests), or unlikely PTB (other respiratory diseases with improvement without tuberculosis treatment).

Results: One hundred fifty-nine children were enrolled (57% boys, median age 26.6 months [interquartile range 15.1-59.3]). Ultrasound detected abnormalities in 72% (n = 114), CXR in 56% (n = 89), P < .001. Pleural effusion was detected on ultrasound in 15% (n = 24) compared 9% (n = 14) on CXR, P = .004, more in confirmed PTB (33%, n = 12 vs 8%, n = 4 unlikely PTB, P = .013). Ultrasound detected enlarged mediastinal lymph nodes more commonly (22%, n = 25) than CXR (6%, n = 10, P = .001); the size of lymph nodes in the unlikely category (1.0 cm) was smaller than the other two PTB categories (1.4 and 1.5 cm, P = .001). Inter-reader agreement (kappa Cohen) was higher for ultrasound than CXR for several findings (consolidation 0.67 vs 0.47, pleural effusion 0.86 vs 0.56, enlarged lymph nodes 0.56 vs 0.27).

Conclusion: Ultrasound detected abnormalities more frequently than CXR with the higher inter-reader agreement; ultrasound abnormalities were most common in children with confirmed PTB. Ultrasound is a promising modality for detecting abnormalities in PTB. Further studies should evaluate the diagnostic accuracy of ultrasound against a gold standard.

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Source
https://onlinelibrary.wiley.com/doi/abs/10.1002/ppul.24500
Publisher Site
http://dx.doi.org/10.1002/ppul.24500DOI Listing
September 2019
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References

(Supplied by CrossRef)

World Health Organization (WHO) et al.
2018
Observer variation in detecting lymphadenopathy on chest radiography
du Toit G et al.
Int J Tuberc Lung Dis 2002
Chest ultrasound for the diagnosis of paediatric pulmonary diseases: a systematic review and meta‐analysis of diagnostic test accuracy
Heuvelings CC et al.
BMB 2018

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