International Journal of Mycobacteriology (Jan 2016)

Determining the lymphadenopathy characteristics of the mediastinum in lung CT scan of children with tuberculosis

  • Payam Mehrian,
  • Amin Momeni Moghaddam,
  • Elham Tavakkol,
  • Afshin Amini,
  • Mehrdad Moghimi,
  • Ali Kabir,
  • Aliakbar Velayati

DOI
https://doi.org/10.1016/j.ijmyco.2016.06.015
Journal volume & issue
Vol. 5, no. 3
pp. 306 – 312

Abstract

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Objective/background: Most tuberculosis cases in children are primary infection, with difficult and imprecise diagnosis mainly based on the existence of mediastinal lymphadenopathy. Here, we investigated the characteristics of mediastinal lymphadenopathy in lung computed tomography (CT) scans of children with tuberculosis. Methods: This cross-sectional study was performed on 75 children with tuberculosis referred to Masih Daneshvari Hospital in Tehran, Iran, from 2009 to 2013. Their medical records were investigated, and CT-scan characteristics were extracted by a radiologist. Results: Mean±standard deviation age of cases was 11.2±4.6 years. CT-scan results indicated 94.7% of cases had lymphadenopathy, with lower paratracheal, upper paratracheal, hilar, and subcarinal forms observed in 81.7%, 69.1%, 53.5%, and 47.9% of cases as the most involved stations in lymph nodes, respectively. In 74.6% of patients with mediastinal lymphadenopathy, perilymph node fat inflammation (matting) was observed, with 52.11% exhibiting conglomeration. Bronchial pressure was observed in 4.23% of children with tuberculosis, and bilateral-, right-, and left-parenchymal involvement was observed in 42.7%, 25.3%, and 8% of these cases, respectively. Left- and right-pleural effusion and calcification was reported in 6.7%, 12%, and 5.6% of patients, respectively. Additionally, nearly 80% of patients exhibited mediastinal lymphadenopathy and lung-parenchyma involvement simultaneously. Lung-parenchyma involvement was significantly correlated with subcarinal (p<.001), hilar (p<.001), subaortic (p = .030), lower paratracheal (p = .037), and axillary (p = .006) stations. Conclusion: Situation of mediastinal lymphadenopathy and its synchronicity with lung-parenchyma involvement can help in differential diagnosis of pulmonary tuberculosis from other lung diseases.

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