Document Detail


Could CT scan avoid unnecessary flexible bronchoscopy in children with active pulmonary tuberculosis? A retrospective study.
MedLine Citation:
PMID:  20172893     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Systematic flexible bronchoscopy is advocated in the initial management of childhood pulmonary tuberculosis.
METHODS: Our aim was to describe and to compare the systematic flexible bronchoscopy findings of 53 children (6.5 + or - 4.4 years; 52.8% boys) with active pulmonary tuberculosis to their initial clinical and radiological (chest x-ray, n=53; CT, n=45) features in an 11-year retrospective study.
RESULTS: Flexible bronchoscopy was normal in 51% of cases. A severe tracheobronchial involvement (extrinsic compression >50% or obstructive endoluminal mass >25% of the lumen) was found in 10 patients. Flexible bronchoscopy guided therapy in 13 cases (steroids n=12, bronchoscopic extraction of a granuloma n=1) and permitted isolation of Mycobacterium tuberculosis in three patients (5.7%). No useful information was obtained by flexible bronchoscopy in 73.5% of cases. No correlation was found between flexible bronchoscopy findings and clinical features or x-ray findings. Conversely, a strong correlation was found between severe bronchoscopic involvement and tracheobronchial luminal narrowing on CT. The CT negative predictive value was 100% (95% CI 91% to 100%). Based on CT results, flexible bronchoscopy could have been avoided in about 60% of our patients.
CONCLUSIONS: Flexible bronchoscopy 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 flexible bronchoscopy in children with pulmonary tuberculosis be limited to those who show tracheobronchial luminal narrowing on an initial CT scan.
Authors:
Kévin Arlaud; Guillaume Gorincour; Julien Bouvenot; Hervé Dutau; Jean-Christophe Dubus
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of disease in childhood     Volume:  95     ISSN:  1468-2044     ISO Abbreviation:  Arch. Dis. Child.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-22     Completed Date:  2010-05-11     Revised Date:  2011-06-29    
Medline Journal Info:
Nlm Unique ID:  0372434     Medline TA:  Arch Dis Child     Country:  England    
Other Details:
Languages:  eng     Pagination:  125-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Pediatrics and CNRS URMITE 6236, University Timone Hospital, Marseille, France.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Bronchoscopy / methods
Child
Child, Preschool
Female
Humans
Infant
Male
Predictive Value of Tests
Retrospective Studies
Tomography, X-Ray Computed
Tuberculosis, Pulmonary / diagnosis,  radiography*
Unnecessary Procedures
Comments/Corrections
Erratum In:
Arch Dis Child. 2011 Jun;96(6):e1

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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