Cavitary pulmonary tuberculosis in children and adolescents: CT features that may mimic necrotizing pneumonia
- 1Present Address: Division of Pediatric Infectious Diseases, University of Health Sciences Turkey, İstanbul Training and Research Hospital, Istanbul, 34098 Türkiye
- 2Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases, Istanbul University, Istanbul, Türkiye
- 3Istanbul Faculty of Medicine, Department of Radiology, Division of Pediatric Radiology, Istanbul University, Istanbul, Türkiye
Abstract
Background: Tuberculosis remains a major infectious cause of morbidity and mortality in children worldwide. Cavitary pulmonary tuberculosis is uncommon in children but may be associated with a high bacillary burden and transmissibility.
Methods: We retrospectively reviewed patients younger than 18 years diagnosed with pulmonary tuberculosis between January 2007 and January 2025 at a tertiary referral center. Cavitary disease was identified on chest computed tomography (CT). Clinical and microbiological data were extracted from medical records. CT examinations were reviewed by a pediatric radiologist blinded to microbiological results. IGRA testing was performed selectively due to limited availability during earlier years of the study period.
Results: Cavitary disease was identified in 8 of 250 children with pulmonary tuberculosis (3.2%). Median age was 14 years (range 11.5–15.5), and five patients were female. History of household or close contact was present in five patients (62.5%). Mean symptom duration was 1.8 months. Sputum smear microscopy was positive in four patients (50%) and culture in six (75%).
Cavities were not confined to the upper lobes and were frequently accompanied by consolidation, a pattern that can overlap with complicated bacterial pneumonia, particularly when lower-lobe involvement is present. Associated CT findings included consolidation (7/8, 87.5%), lymphadenopathy (6/8, 75%), bronchiectasis (5/8, 62.5%) and tree-in-bud opacities (4/8, 50%). All patients completed treatment with clinical and radiological recovery and no relapse during follow-up (median 42 months).
Conclusions: Cavitary pulmonary tuberculosis in children and adolescents may not be confined to the upper lobes and may present with cavitation accompanied by consolidation and other TB-associated CT findings. This pattern can overlap with complicated bacterial pneumonia, particularly in lower-lobe disease. Awareness of this CT pattern may raise suspicion for tuberculosis in cases initially labelled as complicated bacterial pneumonia and prompt timely microbiological testing and appropriate infection control measures.
Related
- S100A8/A9 as a biomarker for differentiating pulmonary tuberculosis from community-acquired pneumonia in children: a multicenter cohort study in China
- Identification of a spatially organized TREM2-associated permissive macrophage niche in human pulmonary tuberculosis alveolar pneumonia.
- A 57-Year-Old With a History of Pulmonary TB Presents With Chronic Hemoptysis and Cavitary Lung Lesion
- Cavitary lung squamous cell carcinoma misdiagnosed as pulmonary aspergillosis following targeted next-generation sequencing : A case report
- Fulminant streptococcal toxic shock syndrome due to autopsy-confirmed emm3 Streptococcus pyogenes necrotizing pneumonia in a patient with COVID-19
BibTeX
@article{erol2026cavitary,
title = {{Cavitary pulmonary tuberculosis in children and adolescents: CT features that may mimic necrotizing pneumonia}},
author = {Mavera Uşaklıoğlu Erol and Behiye Benaygül Kaçmaz and Zuhal Bayramoğlu and Ayşe Büyükcam and Ayper Somer and Selda Hançerli Törün},
journal = {BMC Pediatrics},
year = {2026},
month = aug,
doi = {10.1186/s12887-026-07475-1},
url = {https://doi.org/10.1186/s12887-026-07475-1},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Cavitary pulmonary tuberculosis in children and adolescents: CT features that may mimic necrotizing pneumonia
AU - Mavera Uşaklıoğlu Erol
AU - Behiye Benaygül Kaçmaz
AU - Zuhal Bayramoğlu
AU - Ayşe Büyükcam
AU - Ayper Somer
AU - Selda Hançerli Törün
PY - 2026
DA - 2026/08/05
JO - BMC Pediatrics
DO - 10.1186/s12887-026-07475-1
UR - https://doi.org/10.1186/s12887-026-07475-1
AB - Background: Tuberculosis remains a major infectious cause of morbidity and mortality in children worldwide. Cavitary pulmonary tuberculosis is uncommon in children but may be associated with a high bacillary burden and transmissibility. Methods: We retrospectively reviewed patients younger than 18 years diagnosed with pulmonary tuberculosis between January 2007 and January 2025 at a tertiary referral center. Cavitary disease was identified on chest computed tomography (CT). Clinical and microbiological data were extracted from medical records. CT examinations were reviewed by a pediatric radiologist blinded to microbiological results. IGRA testing was performed selectively due to limited availability during earlier years of the study period. Results: Cavitary disease was identified in 8 of 250 children with pulmonary tuberculosis (3.2%). Median age was 14 years (range 11.5–15.5), and five patients were female. History of household or close contact was present in five patients (62.5%). Mean symptom duration was 1.8 months. Sputum smear microscopy was positive in four patients (50%) and culture in six (75%). Cavities were not confined to the upper lobes and were frequently accompanied by consolidation, a pattern that can overlap with complicated bacterial pneumonia, particularly when lower-lobe involvement is present. Associated CT findings included consolidation (7/8, 87.5%), lymphadenopathy (6/8, 75%), bronchiectasis (5/8, 62.5%) and tree-in-bud opacities (4/8, 50%). All patients completed treatment with clinical and radiological recovery and no relapse during follow-up (median 42 months). Conclusions: Cavitary pulmonary tuberculosis in children and adolescents may not be confined to the upper lobes and may present with cavitation accompanied by consolidation and other TB-associated CT findings. This pattern can overlap with complicated bacterial pneumonia, particularly in lower-lobe disease. Awareness of this CT pattern may raise suspicion for tuberculosis in cases initially labelled as complicated bacterial pneumonia and prompt timely microbiological testing and appropriate infection control measures.
SN - 1471-2431
ER -