Pediatric Tuberculosis Pneumonia

Etiology:
— Mycobacterium tuberculosis
— Inhaled bacillis leads to primary focus which leads to lymphangitic spread which leads to hilar and mediastinal lymphadenopathy which leads to airway compression
— Types are primary (Ghon focus, Ghon complex, Ranke complex) and secondary and miliary
— Methods of spread are bronchogenic, lymphatic, hematogenous to lungs (miliary) and kidneys and liver and brain
Imaging:
— Primary infection most commonly anywhere in lung and has associated ipsilateral adenopathy
— Ghon focus is primary infection in lung
— Ghon complex is primary infection in lung and ipsilateral hilar lymphadenopathy
— Ranke complex is calcified Ghon complex
— Secondary infection is reactivation with infection most commonly in apices (90%) and does not have lymphadenopathy
DDX: Histoplasmosis
Complications: Airway obstruction, endobronchial invasion, hematogenous spread
Treatment: Antibiotics
Clinical: Miliary tuberculosis is uncommon in children and may be associated with immunocompromised patients

Radiology Cases of Tuberculosis Pneumonia

Radiology Cases of Primary Tuberculosis Pneumonia

CXR of pulmonary tuberculosis — CXR AP shows bilateral hilar adenopathy, right greater than left, and a faint right lower lobe infiltrate.

CXR of primary pulmonary tuberculosis — CXR AP and lateral show a dense infiltrate in the right middle lobe along with right hilar adenopathy.

CXR and CT of pulmonary tuberculosis — CXR PA and lateral (above) shows prominence of the superior mediastinum and left hilum. Axial CT with contrast of the chest (below) shows extensive left hilar and subcarinal lymphadenopathy.

CT of pulmonary tuberculosis — Axial CT with contrast of the chest (above) shows a small thick-walled cavitary lesion in the left upper lobe along with some associated opacities peripheral to it as well as in the right upper lobe. MIP axial CT with contrast of the chest (below) shows the entire left lower lobe to be filled with tree-in-bud opacities. There is also a nodular opacity in the anterior right lung.

CXR and chest CT of pulmonary tuberculosis — CXR AP (above) shows prominence of the left hilum. Axial CT without contrast of the chest in soft tissue windows (below left) shows left hilar lymphadenopathy while the lung windows (below right) show next to the left hilar lymphadenopathy an infiltrate with a tree-in-bud pattern in the posterior left lung.

CXR and CT of tuberculosis — CXR and CT of the chest shows bilateral hilar adenopathy and a left upper lobe infiltrate.

CXR of tuberculosis — CXR PA and lateral shows massive bilateral hilar lymphadenopathy with the lungs being clear.

CXR of tuberulosis pneumonia — CXR lateral (right) shows hilar lymphadenopathy which lateralizes to the left on the CXR AP (left) which also shows a dense consolidation in the left upper lobe.

CXR and CT of pulmonary tuberculosis — CXR AP and lateral (above) shows a right paratracheal mass. Axial CT with contrast of the chest (below) shows multiple confluent right paratracheal lymph nodes that extend inferiorly to the level of the carina.

CXR of tuberculosis pneumonia — CXR AP and lateral show bilateral hilar lymphadenopathy and dense consolidation in the right middle lobe.

CXR of pulmonary tuberculosis — CXR AP (above) shows a large amount of right hilar adenopathy. Axial CT without contrast of the chest (below left) shows right hilar and subcarinal adenopathy while the CT (below right) shows the right lower lobe atelectasis caused by the adenopathy.

CXR of pulmonary tuberculosis — CXR AP shows an extensive amount of right hilar lymphadenopathy.

Radiology Cases of Miliary Tuberculosis Pneumonia

CXR of miliary tuberculosis pneumonia — CXR AP shows innumerable small pulmonary nodules that are uniformly distributed throughout the lungs.

CXR of military tuberculosis — CXR AP shows right hilar lymphadenopathy and innumerable small pulmonary nodules that are uniformly distributed throughout the lungs.