Abstract:

Objective: This study aims to evaluate the diagnostic value and therapeutic efficacy of ultrasound in pediatric chest tuberculosis. Methods: A retrospective analysis was performed on 131 confirmed pediatric chest tuberculosis cases admitted to the Student and Pediatric Tuberculosis Ward at the Changsha Central Hospital from May 2023 to May 2024. Demographic data (e.g., gender and age), clinical diagnoses, and chest imaging findings were collected. The diagnostic accuracy of ultrasound was compared with that of chest computed tomography (CT) for detecting chest tuberculosis. For lesions identifiable via ultrasound, the utility of ultrasound in therapeutic response evaluation was further assessed during follow-up. Results: Of the 131 pediatric patients, the detection rates for chest CT and ultrasound were 100.0% (131/131) and 75.6% (99/131), respectively, showing a statistically significant difference (χ²=36.450, P<0.001). Among the cases with lung parenchymal lesions, 85 (64.9%) involved the pleura and were detected by ultrasound, appearing as irregular hypoechoic areas adjacent to the pleura without evidence of bronchial air sign. The remaining 46 cases (35.1%) presented on CT as fibrous, cord-like, spotted, or nodular lesions, without pleural involvement, and were undetectable by ultrasound. The detection rates of pulmonary cavities and mediastinal lymph node enlargement by ultrasound were 33.3% (5/15) and 21.7% (5/23), respectively. A total of 43 pulmonary parenchymal lesions and 19 pleural tuberculosis lesions were monitored by ultrasound during follow-up. Of these, 5 pulmonary parenchymal lesions and 1 pleural tuberculosis lesion showed enlargement, and 5 new pleural lesions were detected in other children during the follow-up period. At the one-month follow-up, the reduction rate of pleural tuberculosis lesions ((14±4) %) was significantly lower than that of pulmonary parenchymal lesions ((43±11) %), with statistical significance (t=2.512, P=0.020). After three months of follow-up, 15 (34.9%) pulmonary parenchymal lesions fully resolved, whereas none (0/19) of the pleural tuberculosis lesions showed complete resolution, demonstrating a statistically significant difference (χ²=6.940, P=0.008). Conclusion: Ultrasound demonstrates comparable diagnostic value to CT in detecting lung parenchymal and pleural lesions involving the pleura in pediatric chest tuberculosis. Moreover, ultrasound offers an irreplaceable advantage in treatment monitoring, making it a preferred modality for follow-up evaluation in most pediatric chest tuberculosis cases.

Key words: Thoracic diseases, Tuberculosis, Child, Ultrasonography, Evaluation studies