Abstract
Tuberculosis in childhood is clinically challenging, but it is a preventable and treatable disease. Risk factors depend on age and immunity status. The most common form of pediatric tuberculosis is pulmonary disease, which comprises more than half of the cases. Other forms make up the extrapulmonary tuberculosis that involves infection of the lymph nodes, central nervous system, gastrointestinal system, hepatobiliary tree, and renal and musculoskeletal systems. Knowledge of the imaging characteristics of pediatric tuberculosis provides clues to diagnosis. This article aims to review the imaging characteristics of common sites for extrapulmonary tuberculous involvement in children.
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References
Perez-Velez CM (2012) Pediatric tuberculosis: new guidelines and recommendations. Curr Opin Pediatr 24:319–328
Cruz AT, Starke JR (2010) Pediatric tuberculosis. Pediatr Rev 31:13–25
Devrim I, Aktürk H, Bayram N et al (2014) Differences between pediatric extra-pulmonary and pulmonary tuberculosis: a warning sign for the future. Mediterr J Hematol Infect Dis 6:e2014058
Modi M, Garg A (2013) Tuberculosis of central nervous system. J Postgrad Med Edu Res 47:202–213
Be NA, Kim KS, Bishai WR et al (2009) Pathogenesis of central nervous system tuberculosis. Curr Mol Med 9:94–99
Patkar D, Narang J, Yanamandala R et al (2012) Central nervous system tuberculosis: pathophysiology and imaging findings. Neuroimaging Clin N Am 22:677–705
Rock RB, Olin M, Baker CA et al (2008) Central nervous system tuberculosis: pathogenesis and clinical aspects. Clin Microbiol Rev 21:243–261
Duque-Silva A, Robsky K, Flood J et al (2015) Risk factors for central nervous system tuberculosis. Pediatrics 136:e1276–e1284
Theron S, Andronikou S, Grobbelaar M et al (2006) Localized basal meningeal enhancement in tuberculous meningitis. Pediatr Radiol 36:11182–11185
Ahluwalia VV, Dayananda SG, Singh TP et al (2013) MRI spectrum of CNS tuberculosis. J Indian Acad Clin Med 14:83–90
Vadivelu S, Effendi S, Starke JR et al (2013) A review of the neurological and neurosurgical implications of tuberculosis in children. Clin Pediatr (Phila) 52:1135–1143
Andronikou S, Wieselthaler N, Smith B et al (2005) Value of early follow-up CT in pediatric tuberculous meningitis. Pediatr Radiol 35:1092–1099
Andronikou S, Wieselthaler N (2004) Modern imaging of tuberculosis in children: thoracic, central nervous system and abdominal tuberculosis. Pediatr Radiol 34:861–875
Reyes-Paguia M, Laya BF, De Jesus JM et al (2011) Accuracy of established cranial CT scan findings in the diagnosis of cranial tuberculosis. St. Luke’s J Med 7:33–42
Andronikou S, Wilmshurst J, Hatherill M et al (2006) Distribution of brain infarction in children with tuberculous meningitis and correlation with outcome score at 6 months. Pediatr Radiol 36:1289–1294
Przybojewski S, Andronikou S, Wilmshurst J (2006) Objective criteria to determine the presence of abnormal basal enhancement in children with suspected tuberculous meningitis. Pediatr Radiol 36:687–696
Botha H, Ackerman C, Candy S et al (2012) Reliability and diagnostic performance of CT imaging criteria in the diagnosis of tuberculous meningitis. PLoS ONE 7:1-8.e38982.
Wallace RC, Burton EM, Barrett FF et al (1991) Intracranial tuberculosis in children: CT appearance and clinical outcome. Pediatr Radiol 21:241–246
Andres MM, Uy JA, Reyes-Paguia MP (2016) Tuberculous meningitis: basal cistern enhancement pattern on CT imaging. World Federation of Pediatric Imaging TB Corner. http://www.wfpiweb.org/Portals/7/Outreach/TB%20Meningitis%20Article.pdf. Accessed 30 Sept 2016
Nogueira Delfino L, Fariello G, Lancella L et al (2012) Central nervous system tuberculosis in non-HIV-positive children: a single-center, 6 year experience. Radiol Med 117:669–678
Du Plessis J, Andronikou S, Wieslthaler N et al (2007) CT features of tuberculous intracranial abscesses in children. Pediatr Radiol 37:167–172
Sahaiu-Srivasta S, Jones B (2008) Brainstem tuberculoma in the immunocompetent: case report and literature review. Clin Neurol Neurosurg 110:302–304
Tinsa F, Essaddam L, Fitouri Z et al (2010) Abdominal tuberculosis in children. J Pediatr Gastroenterol Nutr 50:634–638
Ablin DS, Jain KA, Azouz EM (1994) Abdominal tuberculosis in children. Pediatr Radiol 24:473–477
Sarker DN, Amin R, Mohammed H et al (2011) Abdominal tuberculosis - a review. Bangladesh J Med 22:51–59
Andronikou S, Welman CJ, Kader E (2002) The CT features of abdominal tuberculosis in children. Pediatr Radiol 32:75–81
Zamora JMB, Laya BF, Bautista MW (2011) Computed tomography scan manifestations of abdominal tuberculosis in children. St. Luke’s J Med 7:43–50
Debi U, Ravisankar V, Prasad KK et al (2014) Abdominal tuberculosis of the gastrointestinal tract: revisited. World J Gastroenterol 20:14831–14840
Epstein BM, Mann JH (1982) CT of abdominal tuberculosis. AJR Am J Roentgenol 139:861–866
Yang ZG, Min PQ, Sone S et al (1999) Tuberculosis versus lymphomas in the abdominal lymph nodes: evaluation with contrast- enhanced CT. AJR Am J Roentgenol 172:619–623
Kolawole TM, Lewis EA (1975) A radiologic study of tuberculosis of the abdomen (gastrointestinal tract). Am J Roentgenol Radium Therapy Nucl Med 123:348–358
Zissin R, Gayer G, Chowers M et al (2001) Computerized tomography findings of abdominal tuberculosis: report of 19 cases. Isr Med Assoc J 3:414–418
Ridaura-Sanz C, Lopez-Corella E, Lopez-Ridaura R (2012) Clinical study intestinal/peritoneal tuberculosis in children: an analysis of autopsy cases. Tuberc Res Treat 230814. doi:10.1155/2012/230814
Perez-Solis D, Luyando LH, Callejo-Ortea A et al (2006) Case 90: disseminated tuberculosis. Radiology 238:366–370
Harisinghani MG, McLoud TC, Shepard JA et al (2000) Tuberculosis from head to toe. Radiographics 20:449–470
Balthazar EJ, Gordon R, Hulnick D (1990) Ileocecal tuberculosis: CT and radiologic evaluation. AJR Am J Roentgenol 154:499–503
Engin G, Acunas B, Acunas G et al (2000) Imaging of extrapulmonary tuberculosis. Radiographics 20:471–488
Burrill J, Williams CJ, Bain G et al (2007) Tuberculosis: a radiologic review. Radiographics 27:1255–1273
Vij JC, Malhotra V, Choudhary V et al (1992) A clinicopathological study of abdominal tuberculosis. Indian J Tuberc 39:213–220
Jadvar H, Mindelzun RE, Olcott EW et al (1997) Still the great mimicker: abdominal tuberculosis. AJR Am J Roentgenol 168:1455–1460
Shah S, Thomas V, Mathan M et al (1992) Colonoscopic study of 50 patients with colonic tuberculosis. Gut 33:347–351
Mukewar S, Mukewar S, Ravi R et al (2012) Colon tuberculosis: endoscopic features and prospective endoscopic follow-up after anti-tuberculosis treatment. Clin Transl Gastroenterol 3:e24
Concepcion NDP, De Lima GU (2016) Chronic diarrhea: an unusual symptom of gastrointestinal tuberculosis. World Federation of Pediatric Imaging TB Corner Forum 2:1–10 http://www.wfpiweb.org/Portals/7/Outreach/Chronic%20Diarrhea%20in%20GI%20TB%20-%20TB%20Forum.%20Jan%202016%20final.pdf. Accessed 22 Oct 2016
Karaosmanoglu AD, Onur MR, Sahani DV et al (2016) Hepatobiliary tuberculosis: imaging findings. AJR Am J Roentgenol 207:694–704
Pereira JM, Madureira AJ, Vieira A et al (2005) Abdominal tuberculosis: imaging features. Eur J Radiol 55:173–180
Chong VH (2008) Hepatobiliary tuberculosis: a review of presentations and outcomes. South Med J 101:356–361
Kakkar C, Polnaya AM, Koteshwara P et al (2015) Hepatic tuberculosis: a multimodality imaging review. Insights Imaging 6:647–658
Tatco V, Mejia-Santos MM, Uy JA (2015) The many faces of hepatic tuberculosis. World Federation of Pediatric Imaging TB Corner 1:1–6 http://www.wfpiweb.org/Portals/7/Outreach/Hepatic-TB-Imaging.pdf. Accessed 22 Oct 2016
Levine C (1990) Primary macronodular hepatic tuberculosis: US and CT appearances. Gastrointest Radiol 15:307–309
Palmer P (2002) The imaging of tuberculosis: with epidemiological, pathological, and clinical correlation. Springer, Berlin, Heidelberg, pp 71–74
Yu RS, Zhang SZ, Wu JJ et al (2004) Imaging diagnosis of 12 patients with hepatic tuberculosis. World J Gastroenterol 10:1639–1642
Jeong YJ, Sohn MH, Lim ST et al (2010) ‘Hot liver’ on 18F-FDG PET/CT imaging in a patient with hepatosplenic tuberculosis. Eur J Nucl Med Mol Imaging 37:1618–1619
Park JI (2015) Primary hepatic tuberculosis mimicking intrahepatic cholangiocarcinoma: report of two cases. Ann Surg Treat Res 89:98–101
Ito K, Morooka M, Minamimoto R et al (2013) Imaging spectrum and pitfalls of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with tuberculosis. Jpn J Radiol 31:511–520
Gibson MS, Puckett ML, Shelly ME (2004) Renal tuberculosis. Radiographics 24:251–256
Daher EDF, da Silva GB Jr, Barros EJG (2013) Review: renal tuberculosis in the modern era. AmJTrop Med Hyg 88:54–64
Duicu C, Marginean O, Kiss E et al (2013) Genitourinary tuberculosis in children-diagnostic challenge. Revista Română de Medicină de Laborator 21:301–309
Merchant S, Bharati A, Merchant N (2013) Tuberculosis of the genitourinary system-urinary tract tuberculosis: renal tuberculosis-part I. Indian J Radiol Imaging 23:46–63
Sankhe A, Joshi A (2014) Multidetector CT in renal tuberculosis. Curr Radiol Rep 2:69
Teo HE, Peh WC (2004) Skeletal tuberculosis in children. Pediatr Radiol 34:853–860
Lee KY (2014) Comparison of pyogenic spondylitis and tuberculous spondylitis. Asian Spine J 8:216–223
Kritsaneepaiboon S (2016) Skeletal involvement in pediatric tuberculosis: radiologic imaging manifestations. WFPI TB Corner Forum 2:1–6 http://www.wfpiweb.org/Portals/7/Outreach/4.%20Skeletal%20TB.%20March%202016.pdf. Accessed 22 Oct 2016
Moon MS, Kim SS, Lee BJ et al (2012) Spinal tuberculosis in children: retrospective analysis of 124 patients. Indian J Orthop 46:150–158
Seung OP, Sulaiman W (2012) Osteoarticular tuberculosis mimicking rheumatoid arthritis. Mod Rheumatol 22:931–933
Kwak JH, Lee JH, Kim SH et al (2014) A case of peripheral bone tuberculosis mimicking rheumatoid arthritis. Korean J Med 87:373–378
Rasool MN (2001) Osseous manifestations of tuberculosis in children. J Pediatr Orthop 21:749–755
Agarwal A, Kant KS, Suri T et al (2015) Tuberculosis of the calcaneus in children. J Orthop Surg 23:84–89
Morris BS, Varma R, Garg A et al (2002) Multifocal musculoskeletal tuberculosis in children: appearances on computed tomography. Skelet Radiol 31:1–8
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Kritsaneepaiboon, S., Andres, M.M., Tatco, V.R. et al. Extrapulmonary involvement in pediatric tuberculosis. Pediatr Radiol 47, 1249–1259 (2017). https://doi.org/10.1007/s00247-017-3867-0
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DOI: https://doi.org/10.1007/s00247-017-3867-0