Original Article
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Radiol. Jan 28, 2011; 3(1): 17-23
Published online Jan 28, 2011. doi: 10.4329/wjr.v3.i1.17
CT patterns of nodal disease in pediatric chest tuberculosis
Amar Mukund, Rashmi Khurana, Ashu S Bhalla, Arun K Gupta, Sushil K Kabra
Amar Mukund, Rashmi Khurana, Ashu S Bhalla, Arun K Gupta, Department of Radiology, All India Institute of Medical Sciences, New Delhi 110029, India
Sushil K Kabra, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
Author contributions: Mukund A and Khurana R were responsible for performing the radiological investigation and involved in data analysis; Bhalla AS and Gupta AK were involved in analysis of imaging and manuscript preparation; Kabra SK performed the clinical evaluation of the patients.
Correspondence to: Dr. Ashu S Bhalla, Department of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. ashubhalla1@yahoo.com
Telephone: +91-11-265949258 Fax: +91-11-26588641
Received: December 24, 2010
Revised: January 18, 2011
Accepted: January 25, 2011
Published online: January 28, 2011
Abstract

AIM: To highlight various patterns of nodal involvement and post treatment changes in pediatric chest tuberculosis based on contrast enhanced computed tomography (CECT) scans of chest.

METHODS: This was a retrospective study consisting of 91 patients aged less than 17 years, who attended pediatric OPD of All India Institute of Medical Sciences with clinically diagnosed tuberculosis or with chest radiographs suggestive of chest tuberculosis. These patients had an initial chest radiograph as well as CECT of the chest and follow up imaging after 6 mo, and in some cases 9 mo, of completion of anti-tubercular treatment (ATT). CECT of these patients was reviewed for the location and extent of nodal involvement along with determination of site, size, enhancement pattern and calcification.

RESULTS: Enlargement of mediastinal or hilar lymph nodes was found in 88/91 patients (96.7%), with the most common locations being paratracheal (84.1%), and subcarinal (76.1%). The most common pattern of enhancement was found to be inhomogenous. The nodes were conglomerate in 56.8% and discrete in 43.2%. In addition, perinodal fat was obscured in 84.1% of patients. In the post-treatment scan, there was 87.4% reduction in the size of the nodes. All nodes post-treatment were discrete and homogenous with perinodal fat present. Calcification was found both pre- and post-treatment, but there was an increase in incidence after treatment (41.7%). There was hence a reduction in size, change in enhancement pattern, and appearance of perinodal fat with treatment.

CONCLUSION: Tubercular nodes have varied appearance and enhancement pattern. Conglomeration and obscuration of perinodal fat suggest activity. In residual nodes decision to continue ATT requires clinical correlation.

Keywords: Tuberculosis; Lymph nodes; Contrast enhanced computed tomography