Introduction The chest radiograph (CR) remains a key tool in the diagnosis of pediatric tuberculosis (TB). In children with presumptive intrathoracic TB, we aimed to identify CR features which had high specificity for, and were strongly associated with, bacteriologically confirmed TB. Methods We analyzed CR data from children with presumptive intrathoracic TB prospectively enrolled in a cohort study in a high-TB burden setting and who were classified using standard clinical case definitions as confirmed, unconfirmed or unlikely TB. We report the CR features and inter-reader agreement between expert readers who interpreted the CRs. We calculated the sensitivity and specificity of the CR features with at least moderate inter-reader agreement and analyzed the relationship between these CR features and the classification of TB in a multivariable regression model. Results Of features with at least moderate inter-reader agreement, enlargement of perihilar and/or paratracheal lymph nodes, bronchial deviation/compression, cavities, expansile pneumonia and pleural effusion had a specificity of >90% for confirmed TB, compared to unlikely TB. Enlargement of perihilar (adjusted odds ratio [aOR]: 6.6; 95% confidence interval [CI] 3.80-11.72) and/or paratracheal lymph nodes (aOR: 5.14; 95%CI: 2.25-12.58), bronchial deviation/compression (aOR: 6.22; 95%CI: 2.70-15.69), pleural effusion (aOR: 2.27; 95%CI: 1.04-4.78) and cavities (aOR: 7.45; 95%CI: 3.38-17.45) were associated with confirmed TB in the multivariate regression model while alveolar opacification (aOR: 1.16; 95%CI: 0.76-1.77) and expansile pneumonia (aOR: 4.16; 95%CI: 0.93-22.34) were not. Conclusions In children investigated for intrathoracic TB enlargement of perihilar or paratracheal lymph nodes, bronchial compression/deviation, pleural effusion, or cavities on CR strongly support the diagnosis.

中文翻译：

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胸部X线特征对小儿胸内结核的诊断准确性

简介 胸片 (CR) 仍然是诊断儿童结核病 (TB) 的关键工具。在疑似患有胸腔内结核病的儿童中，我们的目的是确定对细菌学确诊的结核病具有高度特异性并与之密切相关的 CR 特征。方法 我们分析了前瞻性纳入高结核病负担环境中一项队列研究的疑似胸内结核儿童的 CR 数据，并使用标准临床病例定义将这些儿童分类为确诊、未确诊或不太可能的结核病。我们报告 CR 特征以及解释 CR 的专家读者之间的读者间协议。我们计算了具有至少中等读者间一致性的 CR 特征的敏感性和特异性，并在多变量回归模型中分析了这些 CR 特征与结核病分类之间的关系。结果 与不太可能的结核病相比，具有至少中度读者间一致性的特征、肺门周围和/或气管旁淋巴结肿大、支气管偏离/受压、空洞、扩张性肺炎和胸腔积液对确诊结核病的特异性 > 90% 。肺门周围淋巴结肿大（调整后比值比 [aOR]：6.6；95% 置信区间 [CI] 3.80-11.72）和/或气管旁淋巴结增大（aOR：5.14；95%CI：2.25-12.58）、支气管偏离/受压 (aOR) ：6.22；95%CI：2.70-15.69）、胸腔积液（aOR：2.27；95%CI：1.04-4.78）和空洞（aOR：7.45；95%CI：3.38-17.45）与多变量中确诊的结核病相关回归模型，而肺泡混浊（aOR：1.16；95%CI：0.76-1.77）和扩张性肺炎（aOR：4.16；95%CI：0.93-22.34）则不是。结论 在儿童中，检查肺门周围或气管旁淋巴结的胸内结核肿大、支气管受压/偏斜、胸腔积液或 CR 上的空洞，有力地支持了诊断。