Chest X-ray Diagnosis of TB in Children - a crash course

Savvas Andronikou

How this works! Pay attention!

A] This is a quiz of children’s X-rays

– Only 3 possible responses for each

– You have 30 seconds per patient

– Record your answers 1 - 15

B] This is followed by a short training

C] Once ‘educated’ you attempt the same radiographs, recording your ‘new’ answers

D] Expert interpretation follows

Answer options:

A = TB

= enough features to treat for TB B = INCONCLUSIVE = Abnormal BUT inseparable from

other infection C = NORMAL = no abnormality is seen

A] Quiz:

1.

2.

3.

4.

5.

6.

7.

8.

9.

Case 10

11.

12.

13.

14.

15.

Your training is about to begin

AP radiograph

Diagnosis of TB in children =

identify lymphadenopathy

Lymphadenopathy on AP: Hilum should be a hippo’s open mouth Nodes = a cauliflower in the mouth

Right hilar lymphadenopathy Right hilar lymphadenopathy

Left hilar lymphadenopathy Calcified lymphadenopathy

Airways are a up-side-down tree Lymphadenopathy = ‘compressed air-way branches’

Lateral radiograph

Lymphadenopathy on Lateral

• Normal structures (=horseshoe)

• Diverging vessels (=tentacles)

• Lymphadenopathy (=‘doughnut’)

R main pulm art

L main pulm art Top Aortic arch

Lateral: doughnut replaces the horse-shoe and tentacles

Midsagital: subcarinal nodes

Far para-sagital: Left hilar nodes

What makes the doughnut?

Subcarinal and left hilar lymphadenopathy

And there is the doughnut………

Doughnuts and other foods

No mass behind bronchus intermedius

Inconclusive pneumonia? Be Sherlock Holmes and uncover TB

Air space and airway Air space, cavity and airway

Air space expansile and airway Air space, effusion and airway Milliary nodules

Go get them tiger! Grrr!

B] Quiz again:

1.

2.

3.

4.

5.

6.

7.

8.

9.

Case 10

11.

12.

13.

14.

15.

D] ‘Expert’ answers:

He looks like an idiot!

1. TB = A

2. Normal = C

3. TB = A

4. Inconclusive = B

5. Inconclusive = B

6. Normal = C

7.TB = A

8. TB = A

9. Normal = C

10. TB = A

11. Normal = C

12. TB = A

13. TB = A

14. Normal = C

15. TB = A

Can you go it alone?