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Assessment of airway compression on chest radiographs in children with pulmonary tuberculosis

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Abstract

Background

Because small, pliable paediatric airways are easily compressed by enlarged lymph nodes, detection of radiographic airway compression might be an objective criterion for diagnosing pulmonary tuberculosis.

Objective

To investigate the frequency and inter-observer agreement of airway compression on chest radiographs in children with pulmonary tuberculosis compared to those with a different lower respiratory tract infection.

Materials and methods

Chest radiographs of children with suspected pulmonary tuberculosis were read by two readers according to a standardised format and a third reader when there was disagreement. Radiographs of children with proven pulmonary tuberculosis were compared to those with a different lower respiratory tract infection. We evaluated frequency and location of radiographic airway compression. Findings were correlated with human immunodeficiency virus (HIV) status and age. We assessed inter-observer agreement using kappa statistics.

Results

We reviewed radiographs of 505 children (median age 25.9 months, interquartile range [IQR] 14.3–62.2). Radiographic airway compression occurred in 54/188 (28.7%) children with proven pulmonary tuberculosis and in 24/317 (7.6%) children with other types of lower respiratory tract infection (odds ratio [OR] 4.9; 95% confidence interval [CI] 2.9–8.3). A higher frequency of radiographic airway compression occurred in infants (22/101, or 21.8%) compared to older children (56/404, or 13.9%; OR 1.7; 95% CI 1.0–3.0). We found no association between airway compression and HIV infection. Inter-observer agreement ranged from none to fair (kappa of 0.0–0.4).

Conclusion

There is a strong association between airway compression on chest radiographs and confirmed pulmonary tuberculosis. However this finding’s clinical use as an objective criterion for diagnosis of pulmonary tuberculosis in children is limited by poor inter-observer agreement.

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Acknowledgements

We thank the clinical and data study staff at Red Cross Children’s War Memorial Hospital, the microbiology laboratory team, the radiology department and expert team, and the children and their caregivers for participating in this study. The core study and database from which this study was derived was funded by the National Institutes of Health, USA (R01HD058971), the National Health Laboratory Services Research Trust, the Medical Research Council of South Africa and the National Research Foundation of South Africa.

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Authors and Affiliations

  1. Department of Radiology, Groote Schuur Hospital and University of Cape Town, Main Rd, Observatory, Cape Town, 7935, South Africa

    Lisel Richter-Joubert & Savvas Andronikou

  2. Department of Paediatric Radiology, Bristol Royal Hospital for Children and the University of Bristol, Bristol, UK

    Savvas Andronikou

  3. Department of Paediatrics and Child Health and MRC Unit on Child and Adolescent Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa

    Lesley Workman & Heather J. Zar

Authors
  1. Lisel Richter-Joubert
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  2. Savvas Andronikou
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  3. Lesley Workman
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  4. Heather J. Zar
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Correspondence to Lisel Richter-Joubert.

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Richter-Joubert, L., Andronikou, S., Workman, L. et al. Assessment of airway compression on chest radiographs in children with pulmonary tuberculosis. Pediatr Radiol 47, 1283–1291 (2017). https://doi.org/10.1007/s00247-017-3887-9

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  • DOI: https://doi.org/10.1007/s00247-017-3887-9

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