Serial chest radiographs in the management of children with a clinical suspicion of pulmonary tuberculosis.

The aim of the study was to define the role of serial chest radiographs (SCR) in the management of children with a clinical suspicion of pulmonary tuberculosis (PTB) and to determine the interval at which they should be taken. Eighty children with a clinical suspicion of PTB were studied and followed-up for a duration of 18 months. SCR during the time of treatment were taken at monthly intervals for the first 3 months, then at 2-monthly intervals up to the end of therapy, and finally 2 months post-therapy. These were reviewed and the changes while on treatment noted and correlated with the clinical picture. Lung opacities were observed in 73 children (91 per cent) and were the most common radiological finding on the initial chest X-ray. These were followed by reduced chest wall muscle bulk present in 66 children (83 per cent). Mediastinal and/or hilar lymphadenopathy was noted in 47 children with a significant occurrence in the 0-4 age group (p = 0.004). Pleural effusions, cavities and calcification were rare. Human immunodeficiency virus (HIV) seropositive children with PTB accounted for 87 per cent and carried a poor prognosis (p = 0.0007). The common chest radiographic findings in children with PTB include lung opacities with hilar/mediastinal lymphadenopathy. Pleural effusions, cavitation, calcifications, miliary spread and normal chest X-rays were rare. SCR are useful in monitoring response to treatment, detection of onset of secondary infections and complications. HIV positive patients carry a poor prognosis. Based on the results of this study, pre-treatment, 2 months after onset of treatment, and end of therapy radiographs are recommended as routine in children with a clinical suspicion of PTB.