Harris Debra,  Maniyar Jenny,  Dixon Rachel,  Turnbull Louise,  Dominiak Kate,  Kapadia Tejas

Final Pr. ID: Poster #: EDU-020

TB remains one of the most significant causes of morbidity and mortality in children worldwide. In the Northwest of England, UK we report an incidence of approximately 1.4 per 100,000 under 15 years of age. Diagnosis and management are subtle and complex. We explain the insensitivity of the screening tests currently available and widely relied upon in the adult sector.
We highlight the importance of multidisciplinary team working exemplified by our Network model in the Northwest region of England. This virtual forum meets weekly and includes radiologists, pulmonologists, specialist nurses, infectious disease specialists and local clinicians. We discuss all new TB cases across the region, present imaging findings and document all decisions.
We review these cases until discharge encompassing imaging findings in the acute disease phase, treatment phase and post infectious stage. These may go on to affect quality and length of life and include but are not limited to fibrotic scarring, bronchiectasis and intrapulmonary/pleural calcifications.
We have extensive data from our virtual network (the largest in the United Kingdom) and will use this poster to show multiple high quality cases to highlight the importance of multidisciplinary team working. Read More

Authors:  Harris Debra , Maniyar Jenny , Dixon Rachel , Turnbull Louise , Dominiak Kate , Kapadia Tejas

Keywords:  Tuberculosis, Multidisciplinary Education, Thoracic

Maniyar Jenny,  Harris Debra,  Dixon Rachel,  Turnbull Louise,  Dominiak Kate,  Kapadia Tejas

Final Pr. ID: Poster #: EDU-117

As the regional referral centre for paediatric tuberculosis (TB) in Northwest England, we conducted a retrospective review of referrals to assess indications for CT imaging based on clinical presentation and chest X-ray (CXR) findings. A literature review was performed addressing latent TB detection, radiographic features in infants, the WHO End TB strategy, and NICE guidelines.
CXR sensitivity for latent TB detection is as low as 15%, whereas CT imaging, despite higher radiation exposure, offers superior diagnostic accuracy. Guidelines recommend contrast-enhanced CT when CXR findings are inconclusive or diagnostic uncertainty exists.
Our multicentre review identified CT indications including equivocal or abnormal CXRs, extrapulmonary lymphadenopathy, and suspected airway compression. Integral to our protocol is a region-wide multidisciplinary team (MDT) comprising paediatricians, radiologists, infectious disease, and respiratory specialists. The MDT convenes weekly to integrate clinical and radiological data, guiding imaging decisions and management.
This collaborative approach ensures tailored, low-dose CT protocols with expedited reporting, enhancing diagnostic confidence and patient outcomes. The MDT also facilitates consideration of differential diagnoses, including malignancy and steroid effects.
Our findings highlight the critical role of coordinated MDT discussion and protocol adherence in optimizing imaging strategies and improving paediatric TB care. Read More

Authors:  Maniyar Jenny , Harris Debra , Dixon Rachel , Turnbull Louise , Dominiak Kate , Kapadia Tejas

Keywords:  Tuberculosis, Multidisciplinary Education, Thoracic

Venkatakrishna Shyam Sunder,  Chiang Silvia S.,  Lecca Leonid,  Byrne Anthony L.,  Andronikou Savvas

Final Pr. ID: Poster #: SCI-031

Although Tuberculosis (TB) is very common in early childhood, we see an increased incidence of TB in adolescents due to increased susceptibility. It is also important to note that adolescent TB affects those living in low/middle income countries where TB is very common. There is a paucity of literature regarding the sequelae of TB disease in adolescents based on advanced cross-sectional imaging. We aimed to review the imaging features seen on CT imaging of the chest post adolescent TB in a cohort of patients from Peru. Read More

Authors:  Venkatakrishna Shyam Sunder , Chiang Silvia S. , Lecca Leonid , Byrne Anthony L. , Andronikou Savvas

Keywords:  Tuberculosis, Adolescent, CT

Calle Toro Juan,  Bester Dewald,  Venkatakrishna Shyam Sunder,  Ali Krim Ahmed,  Lucas Susan,  Goussard Pierre,  Andronikou Savvas

Final Pr. ID: Poster #: SCI-036

Suspected airway compression in symptomatic children with Lymphobronchial Tuberculosis (LBTB) can be diagnosed using modern computed tomography (CT) assisted by coronal minimum intensity projection (MinIP) reconstructions. The accuracy of plain radiographs in detecting airway compression in children with TB has not been evaluated against an imaging gold standard in a dedicated manner.

We aimed to compare frontal CXR against thick-slab angled coronal CT MinIP in identifying airway stenosis at ten specific sites and to determine the agreement between the modalities regarding the degree of stenosis. Read More

Authors:  Calle Toro Juan , Bester Dewald , Venkatakrishna Shyam Sunder , Ali Krim Ahmed , Lucas Susan , Goussard Pierre , Andronikou Savvas

Keywords:  Lymphobronchial Tuberculosis, minimum intensity projection, computed tomography

Heuvelings Charlotte,  Belard Sabine,  Andronikou Savvas,  Grobusch Martin,  Zar Heather

Final Pr. ID: Poster #: SCI-020

Diagnosing paediatric TB can be challenging due to non-specific signs and symptoms and difficulties in getting a microbiological confirmation. Diagnosis relies mainly on symptoms and chest X-ray (CXR), with hilar or mediastinal lymphadenopathy as the most common finding. However, CXR has poor inter- and intra-reader agreement for mediastinal lymphadenopathy. Ultrasound (US) does not expose children to ionizing radiation; is repeatable and due to the recent development of portable, low-cost US machines it can be used at the point of care and is cost-effective.
We investigated clinician-performed mediastinal US, comparing with CXR, for the detection of lymphadenopathy in children with suspected pulmonary TB. Read More

Authors:  Heuvelings Charlotte , Belard Sabine , Andronikou Savvas , Grobusch Martin , Zar Heather

Keywords:  mediastinal, ultrasound, tuberculosis

Alian Ali,  Pfeifer Cory

Final Pr. ID: Poster #: EDU-095

In 2017, children under the age of 15 accounted for only 10% of the 10 million Mycobacterium tuberculosis (TB) infections estimated by the World Health Organization. Child carriers of TB pose health risks to their adult caregivers, and children can exhibit greater susceptibility to significant health risks from the infection. Nontuberculous mycobacterial (NTM) infection presents disparate health risks and can generate imaging specific findings. This presentation addresses radiologic manifestations of mycobacterial disease as a means to educate pediatric radiologists given the medical significance of mycobacterial infection. Read More

Authors:  Alian Ali , Pfeifer Cory

Keywords:  tuberculosis, infection, multi-system

Heuvelings Charlotte,  Belard Sabine,  Andronikou Savvas,  Grobusch Martin,  Zar Heather

Final Pr. ID: Poster #: SCI-043

Diagnosing pediatric pulmonary tuberculosis (PTB) may be challenging as getting microbiological confirmation is difficult. Chest X-Ray (CXR) involves radiation exposure and has poor inter-reader agreement. Mediastinal lymphadenopathy can also be detected by mediastinal ultrasound (US). We describe technical aspects of performing mediastinal US and the findings in children with suspected PTB. Read More

Authors:  Heuvelings Charlotte , Belard Sabine , Andronikou Savvas , Grobusch Martin , Zar Heather

Keywords:  Mediastinal Ultrasound, Technical aspects, Tuberculosis

Deaver Pamela,  Masand Prakash

Final Pr. ID: Poster #: CR-048

In a child with escalating hemoptysis, negative TB testing, and history of penetrating thoracic trauma, chronic inflammation and vascular injury as a result of radiolucent foreign body should be considered. Read More

Authors:  Deaver Pamela , Masand Prakash

Keywords:  Foreign Body, Pseudoaneurysm, Tuberculosis

Arévalo Mary,  Paramo Garcia Laura,  Romero Baizabal Bertha

Final Pr. ID: Poster #: CR-005 (S)

El abdomen es el sitio más común de tuberculosis extraperitoneal, siendo las linfadenopatías mesentéricas y peripancréaticas, la manifestación más frecuente en hasta el 55-65% de pacientes. La tomografía es el principal método de imagen usado para su evaluación.
La presencia de obstrucción biliar, gastrointestinal o genitourinaria sugiere un diagnóstico alternativo.
Read More

Authors:  Arévalo Mary , Paramo Garcia Laura , Romero Baizabal Bertha

Keywords:  Granulomatous diseases, Tuberculosis

Di Puglia Elazir,  Fazecas Tatiana,  Penna Claudia,  Porto Miriam,  Guedes Bianca,  Waksman Maria Gabriela

Final Pr. ID: Poster #: EDU-019 (S)

- To review the ethiopathogenesis of tuberculosis (TB);
- To discuss clinical and epidemiological variables, as well the radiological findings seen in radiography, ultrasound (US), computed tomography (CT) and magnetic resonance (MR) imaging performed due to clinical suspicion of TB;
- To review and widely ilustrated in this paper the imaging findings in TB.

Read More

Authors:  Di Puglia Elazir , Fazecas Tatiana , Penna Claudia , Porto Miriam , Guedes Bianca , Waksman Maria Gabriela

Keywords:  Tuberculosis, disseminated, pulmonary

Venkatakrishna Shyam Sunder,  Vasileiadi Eleana,  Siu Navarro Youck Jen,  Villavicencio Karen L Hanze,  Miranda Schaeubinger Monica,  Schoeman Sean,  Otero Hansel,  Andronikou Savvas

Final Pr. ID: Poster #: CR-036

Tuberculous meningitis (TBM) causes significant morbidity and mortality in young children. Early treatment can be initiated with MR imaging diagnosis. We present MR detectable miliary meningeal TB in two patients presenting in a developed world setting.
Case 1: A 9 y/o girl of Haitian descent, developed fevers, cough, lethargy and seizures. Brain MRI demonstrated multiple, small, T2-dark, rim-enhancing lesions, associated with cranial nerve and leptomeningeal enhancement. Chest CT showed mediastinal lymphadenopathy, multiple small interstitial lung nodules and a splenic hypo enhancing lesion. CSF showed pleocytosis, low glucose, and high protein. She was started on 4-drug treatment for TBM and dexamethasone. Serial bronchoalveolar lavage was Xpert MTB/RIF and acid-fast negative. Contact tracing revealed a remote positive contact with pulmonary tuberculosis from Haiti. Endobronchial US-guided biopsy of a subcarinal lymph node was positive for Xpert MTB PCR.

Case 2: A 17 y/o female with Crohn’s disease on adalimumab developed refractory ear infections despite multiple courses of antibiotics and underwent myringotomy, with negative aerobic ear fluid culture. She had two chronic skin lesions. Brain MRI, obtained due to persistent otorrhea, showed multiple, small, round, T2-dark lesions. CSF studies were unremarkable. CT chest, abdomen and pelvis showed left upper lobe tree-in-bud nodules, hypoattenuating splenic lesions and a left obturator internus abscess with adjacent osteomyelitis. She underwent CT guided aspiration of the obturator muscle collection, bronchoscopy with Bronchoalveolar Lavage (BAL), biopsy of her skin lesions and ear fluid aspiration. QuantiFERON Gold was positive. Ear fluid was Xpert MTB/RIF assay and acid-fast stain positive. She was started on 4-drug therapy and prednisone. Cultures from the ear fluid, skin tissue, muscle tissue and BAL showed growth of acid-fast bacilli.

TB meningitis is most often due to blood borne spread of the disease from the lungs which may result in miliary nodules in the leptomeninges and brain. The two cases presented illustrate that although TBM is unusual in a developed world, we should suspect it in children of migrants as well as in patients with immunosuppression, where atypical imaging patterns including lack of typical basal enhancement and presence of miliary meningeal nodules may be seen. Read More

Authors:  Venkatakrishna Shyam Sunder , Vasileiadi Eleana , Siu Navarro Youck Jen , Villavicencio Karen L Hanze , Miranda Schaeubinger Monica , Schoeman Sean , Otero Hansel , Andronikou Savvas

Keywords:  Miliary Meningeal Tuberculosis