© 2009 BMJ Publishing Group & Royal College of Paediatrics and Child Health
Could CT-scan avoid unnecessary flexible bronchoscopy in children with active pulmonary tuberculosis ? A retrospective study
1 CHU Timone-Enfants, France;
2 CHU Timone, France;
3 CHU Sainte-Marguerite, France
Correspondence to: Jean-Christophe Dubus, Unité de Médecine Infantile, CHU Timone-Enfants, 265 rue Saint-Pierre, Marseille, 13385, France; jean-christophe.dubus{at}ap-hm.fr
Accepted 4 September 2009
Background: Systematic flexible bronchoscopy (FB) is advocated in the initial management of childhood pulmonary tuberculosis.
Methods: Our aim was to describe and to compare the systematic FB findings of 53 children (6.5 ± 4.4 years; 52.8% boys) with active pulmonary tuberculosis to their initial clinical and radiological (chest X-Ray, n=53; computerized tomography (CT), n=45) features in a 11-year retrospective study.
Results: FB was normal in 51% of the cases. A severe tracheobronchial involvement (extrinsic compression >50% or obstructive endoluminal mass >25% of the lumen) was found in 10 patients. FB guided therapy in 13 cases (steroids n=12, bronchoscopic extraction of a granuloma n=1) and permitted to isolate Mycobacterium tuberculosis in 3 patients (5.7%). No useful information was obtained by FB in 73.5% of the cases. No correlation was found between FB findings and clinical features or X-Ray findings. Conversely, a strong correlation was found between severe bronchoscopic involvement and tracheobronchial luminal narrowing on CT. CT negative predictive value was 100% (95% confidence interval = 91-100%). Based upon CT results, FB could have been avoided in about 60% of our patients.
Conclusions: FB remains a very relevant tool in the diagnostic and therapeutic management of childhood pulmonary tuberculosis but resulted in treatment modification or microbiological proof in a minority of our patients. We propose that FB in children with pulmonary tuberculosis might be limited to those who show tracheobronchial luminal narrowing on an initial CT scan.
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