Article Text

This article has a correction. Please see:

other Versions

PDF
Could CT-scan avoid unnecessary flexible bronchoscopy in children with active pulmonary tuberculosis ? A retrospective study
  1. Kevin Arlaud1,
  2. Guillaume Gorincour1,
  3. Julien Bouvenot2,
  4. Hervé Dutau3,
  5. Jean-Christophe Dubus1,*
  1. 1 CHU Timone-Enfants, France;
  2. 2 CHU Timone, France;
  3. 3 CHU Sainte-Marguerite, France
  1. 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

Abstract

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.

Statistics from Altmetric.com

Footnotes

    Request permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Linked Articles

    • Electronic pages
      BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health