Q)What are the radiographic 
manifestations of childhood tuberculosis?

A: In a developing country like ours, tuberculosis may have broad spectrum of manifestations ranging from consolidation, lymphadenopathy or miliary shadows. The disease is acquired by inhalation from other infected persons. It may be widespread with meningitis or diffuse pulmonary involvement - may appear radiographically as widespread alveolar infiltrates or as miliary nodules.

Primary complex may manifest a small area of peripheral consolidation (Ghon focus) with a lymph node. Apicoposterior segment of an upper lobe or apical segment of a lower lobe commonly shows consolidation.

Pleural effusion & lymphadenopathy are common associated finding.

Hilar, paratracheal lymph nodes are commonly involved. Though adenopathy is infrequently seen with bacterial/viral infection, histoplasmosis may be a differential diagnosis. Rarely obstructive overinflation of a lobe may be caused by extrinsic bronchial compression by adjacent TB lymph node or endobronchial extension of infection.

Miliary opacities range from 1-2 mm. They are diffuse & of soft tissue density.

Silicosis, berylliosis, sarcoidosis & rarely metastasis cause miliary opacities. Thus, a pnemonia with lymphadenopathy or miliary shadows should cause suspicion or tuberculosis.

Miliary TB

Pneumonia with hilum enlarged

Paratracheal hilar LN