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Bismillah

The Roles of CTxR


in
Children Lung TB

Edy Moeljono

PDSRAI, Semarang
17 Desember 2006
Tuberculosis / TB

 TB continous to be a common problem faced


by primary care physician.

 Detection of TB infection in child → associate


detection → Discovery of adult with TB.
The Roles of Radiology

1. Diagnosis
2. Locating & Extention of Disease
3. Treatment Respons
4. Detecting Complications
5. Detecting Presdiposing Chest Disease
CTxR for Lung Disease

 NEITHER SENSITIVE
NOR SPECIFIC

→SUGGESTIVE
Lung TB

 MTb ~ 95 % of Mycobacterium
 Droplet ≤ 5μm
→ Alveolies / Airspace
 Droplet > 5μm
→ Airways
 Hematogen
→ Interstitial
Terminology

 Primary TB : Previously unexposed


 Post Primary TB : Previously exposed
or
BCG vaccinated
 Progressive Primary TB : PTB → PPTB without break
 Primary Complex Pulmonary TB
M.Tb → Alveolies → Ghon Focus
Lymphangitis
Lymphadenitis
TUBERCULOSIS

I. Endothoracic / Lung TB

II. Extrathoracic TB
I. ENDOTHORACIC / LUNG TB

1. Primary Pulmonary TB
2. Endobronchial TB
3. Pleurisy of TB
4. Progressiv Primary TB
5. Milliary TB
6. Post Primary TB
II. EXTRATHORACIC TB

1. URT (Laryx, Pharyng, Epiglottis) TB


2. Lymphnodes TB
3. Meningitis TB
4. Skin TB
5. Heart Percardium TB
6. Abdominal TB
7. Bone-Joint TB
8. Urogenital TB
9. Eye TB
CHILDREN LUNG TB

 Primary TB :
Primary Pulmonary TB & Complications
Endobronchial TB & Complications
 Progressive Primary TB :
Milliary TB
 Post Primary TB
 Extrathoracic TB :
Lymphnodes TB
Primary TB

Primary Pulmonary TB & Complications

Endobronchial TB & Complications


Primary Pulmonary TB
Primary Pulmonary TB
Primary Pulmonary TB

Hillar Lymphadenopaties
Complications of
Primary Pulmonary TB

A. Ghon Focus Complications


1. Coin Lession
2. Effusion → Pleurisity sicca
3. Cavity
4. Paratracheal Lymphadenopaty
A. Ghon Focus Complications

Coin Lesion Pleural Effusion


A. Ghon Focus Complications

Cavity Paratracheal lymphadenopathy


Complications of Primary Pulmonary TB

B. Lymphadenopaty Complications
1. Hyperinflations
2. Atelectasis
3. Bronchial Spreading
4. Pericardial Effusion
B. Lymphadenopaty Complications

Hyperinflation Atelectasis
B. Lymphadenopaty Complications

Pericardial Effusion
Primary TB

Primary Pulmonary TB & Complications


Endobronchial TB & Complications
Endobronchial TB
Endobronchial TB

 Hyperinflation

 Atelectasis
Endobronchial TB
Endobronchial TB Complications

1. Bronchial Spreading
2. Stricture of the bronchial trees
3. Bronchiectasis
4. Fibrosis
Endobronchial TB Complication

Bronchiectasis
CHILDREN LUNG TB

 Primary TB :
Primary Pulmonary TB & Complications
Endobronchial TB & Complications
 Progressive Primary TB :
Milliary TB
 Post Primary TB
 Extrathoracic TB :
Lymphnodes TB
Progressive Primary TB

 The primary disease


passes into
the postprimary form
WITHOUT a break.

 “Wallgreen Timetable”
Complications of nodes
Complications of focus 1. Extension into bronchus
1. Effusion 2. Consolidation
2. Cavitation 3. Hyperinflation
3. Coin shadow

EVOLUTION AND TIMETABLE OF


UNTREATED PRIMARY TUBERCULOSIS
IN CHILDREN
MENINGITIS OR MILIARY
in 4% of children infected
under 5 years of age
LATE COMPLICATIONS
Renal & Skin
Most children Most after 5 years
become tuberculin BRONCHIAL EROSION
sensitive
3-9 months
Uncommon under 5 years of age Incidence decreases
PRIMARY COMPLEX 25% of cases within 3 months As age increased
A minority of children 75% of cases within 6 months
Progressive Healing
experience :
Most cases
1. Febrile illness
BONE LESION
2. Erythema Nodosum Most within
3. Phlyctenular Conjunctivitis
1 2 3 4 3 years
5 6

Resistance reduced :
infection 1. Early infection
(esp. in first year)
2. Malnutrition
3. Repeated infections :
measles, whooping cough 24 months
4-8 weeks 3-4 weeks fever of onset 12 months streptococcal infections
4. Steroid therapy
Development
Of Complex DIMINISHING RISK

But still possible


GREATEST RISK OF LOCAL & DISEMINATED LESIONS 90% in first 2 years Miller FJW. Tuberculosis in children, 1982
Milliary TB

 Hematogenous Spreading
CHILDREN LUNG TB

 Primary TB :
Primary Pulmonary TB & Complications
Endobronchial TB & Complications
 Progressive Primary TB :
Milliary TB
 Post Primary TB
 Extrathoracic TB :
Lymphnodes TB
Post Primary TB

 Like the adult type


CHILDREN LUNG TB

 Primary TB :
Primary Pulmonary TB & Complications
Endobronchial TB & Complications
 Progressive Primary TB :
Milliary TB
 Post Primary TB
 Extrathoracic TB :
Lymphnodes TB
Extrathoracic TB

Axillar
Lymphnodes
Calcifications
CONCLUSION

Grainger & Allison's Diagnostic Radiology


Alhamdulillah…

Thanks…