Chest x-ray

Clinical description

CXR can be a useful tool for diagnosing TB, but TB disease should not be diagnosed from the CXR alone. The whole clinical picture should be considered.

When interpreting CXR note the following:

• X-ray changes are often non-specific.
• CXRs can appear normal in HIV-infected or malnourished children despite advanced

TB disease.

• Interpretation depends on technique, quality of the x-ray, and expertise of the reader.

The most common x-ray findings suggesting TB in children are:

• Persistent opacification in the lung together with enlarged peri-hilar and subcarinal

lymph nodes as evidenced by splaying of the right and left main bronchi, and/or

• A widened mediastinum due to enlarged lymph nodes (this is the most common x-ray

abnormality in children with TB).

• Unilateral infiltration on x-ray, which may indicate lobar disease.
• Diffuse uniformly distributed Miliary shadows.
• One-sided pleural effusions usually occur in children > 5 years of age.
• Cavitation (tends to occur in older children)
• Pleural or pericardial effusions are forms of EPTB that tend to occur in older children
• The finding of marked abnormality on CXR in a child with no signs of respiratory

distress (no fast

• Adolescent (those 10 – 18 years of age) patients with TB can have radiographic changes

similar to adults, with large pleural effusions and apical infiltrates with cavity formation being the most common form of presentation.

• Adolescents may also develop primary cavitary disease with hilar adenopathy and

collapse lesions.

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