Expansile pneumonia in children caused by Mycobacterium tuberculosis: clinical, radiological, and bronchoscopic appearances.
A cohort of 24 children with expansile pneumonia caused by Mycobacterium tuberculosis is described in mostly HIV-noninfected children (n = 22). The children presented with nonresolving pneumonia and a swinging fever (83%). On chest radiography, they had dense opacification with bulging fissures mainly in the upper lobes (75%). On computed tomography, the lobes are consolidated, with areas of liquefacation. Other features visible are enlarged mediastinal lymph adenopathy with ring enhancement (100%), cavities (63%), and tracheal compression (71%). On bronchoscopy, bronchi were obstructed by more than 75% in 20 (83%) of cases. Lymph gland enucleation was required in 42% of cases. Phrenic nerve palsy was present in 3 children, of whom 2 underwent diaphragmatic plication. The children received standard antituberculous therapy, to which prednisone (2 mg/kg/day) was added for 1 month. The mortality was 4% after 6 months of therapy.
Goussard
P
P
Department of Paediatrics and Child Health, Stellenbosch University, PO Box 19063, Tygerberg 7505, South Africa. pgouss@sun.ac.za
Gie
R P
RP
Kling
S
S
Beyers
N
N
D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008168:Lung / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D009169:Mycobacterium tuberculosis; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000382:microbiology* / Q000628:therapy; D011446:Prospective Studies; D011859:Radiography; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000628:therapy