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 (SC R) in the management of children with a clinical suspicion of pulmonary tub erculosis (PTB) and to determine the interval at which they should be taken . Eighty children with a clinical suspicion of PTB were studied and followe d-up for a duration of 18 months. SCR during the time of treatment were tak en 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 re viewed and the changes while on treatment noted and correlated with the cli nical picture. Lung opacities were observed in 73 children (91 per cent) an d were the most common radiological finding on the initial chest X-ray. The se were followed by reduced chest wall muscle bulk present in 66 children ( 83 per cent). Mediastinal and/or hilar lymphadenopathy was noted in 47 chil dren with a significant occurrence in the 0-4 age group (p = 0.004). Pleura l effusions, cavities and calcification were rare. Human immunodeficiency v irus (HIV) seropositive children with PTB accounted for 87 per cent and car ried a poor prognosis (p = 0.0007). The common chest radiographic findings in children with PTB include lung opacities with hilar/mediastinal lymphade nopathy. Pleural effusions, cavitation, calcifications, miliary spread and normal chest X-rays were rare. SCR are useful in monitoring response to tre atment, detection of onset of secondary infections and complications. HIV p ositive patients carry a poor prognosis. Based on the results of this study , pre-treatment, 2 months after onset of treatment, and end of therapy radi ographs are recommended as routine in children with a clinical suspicion of PTB.