title: Infantile pulmonary tuberculosis: the great mimic.
abstract: OBJECTIVE
  Infantile tuberculosis is common in developing countries and rarely presents as space occupying thoracic lesions mimicking congenital malformations. This case series reviews four such infants with varied presentations and their outcome.
  
  
  METHODS
  Four cases of infantile pulmonary/mediastinal tuberculosis that presented like congenital thoracic lesions are described. Details of demography, symptomatology, contact history, immunization status, provisional diagnosis, tuberculin testing, imaging, histopathology, final diagnosis, management and outcome were retrospectively collated and analyzed.
  
  
  RESULTS
  They were 4-6-month males, term-born and immunized. They presented with pneumonia/hyperactive airway disease since 2-12 weeks. One had a suspect and another a close tuberculous contact. The provisional diagnosis after imaging were infected congenital lung cyst, posterior mediastinal cyst and bronchopulmonary malformation. Two were tuberculin positive; none had gastric acid-fast bacilli. One underwent a pulmonary lobectomy for necrotic lung cyst; the second had a biopsy and drainage of a posterior mediastinal cyst that contained caseating material and was densely adherent to the esophagus. Surgical biopsy showed necrotizing granulomatous inflammation in both; one with acid-fast bacilli. Both succumbed to postoperative complications. The other two with tuberculous contacts who were managed with early antituberculous therapy, responded well and recovered uneventfully.
  
  
  CONCLUSIONS
  Infantile pulmonary/mediastinal tuberculosis may mimic congenital thoracic malformations. A review of contact history, investigations and imaging help to establish the tuberculous etiology, avoids surgical misadventures and prompts early antituberculous therapy to achieve a favorable outcome.
authors.affiliation: Department of Paediatric Surgery, St. John's Medical College Hospital, St. John's National Academy of Health Sciences, Bangalore, 560034, India.
authors.forename: Roma Subhash
authors.initials: RS
authors.lastname: Varik
authors.forename: Attibele Mahadevaiah
authors.initials: AM
authors.lastname: Shubha
authors.forename: Maria
authors.initials: M
authors.lastname: Lewin
authors.forename: Betty
authors.initials: B
authors.lastname: Alexander
authors.forename: Usha
authors.initials: U
authors.lastname: Kini
authors.forename: Kanishka
authors.initials: K
authors.lastname: Das
mesh_terms: D000013:Congenital Abnormalities / Q000175:diagnosis; D003937:Diagnosis, Differential; D006801:Humans; D007223:Infant; D008168:Lung / Q000002:abnormalities; D008297:Male; D012189:Retrospective Studies; D013909:Thorax / Q000002:abnormalities; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*