Radiology of Pediatric Tuberculosis
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Review
VOLUME: 14 ISSUE: 2
P: 293 - 310
August 2026

Radiology of Pediatric Tuberculosis

Turk Radiol Semin 2026;14(2):293-310
1. Ondokuz Mayıs Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Çocuk Radyolojisi Bilim Dalı, Samsun, Türkiye
2. Hacettepe Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Çocuk Radyolojisi Bilim Dalı, Ankara, Türkiye
No information available.
No information available
Received Date: 05.05.2026
Accepted Date: 26.06.2026
Online Date: 25.08.2026
Publish Date: 25.08.2026
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ABSTRACT

Tuberculosis, known as “the great mimicker”, can affect virtually any organ and present with remarkably variable clinical and radiological manifestations, causing significant morbidity and mortality in children. This review addresses current approaches to pediatric tuberculosis, with a focus on fundamental patterns of involvement and key imaging characteristics.

Keywords:
Tuberculosis, lymphadenitis, ultrasonography, computed tomography, magnetic resonance imaging

References

1
Gutierrez MC, Brisse S, Brosch R, Fabre M, Omaïs B, Marmiesse M, et al. Ancient origin and gene mosaicism of the progenitor of Mycobacterium tuberculosis. PLoS Pathog. 2005; 1: e5.
2
Nerlich AG, Haas CJ, Zink A, Szeimies U, Hagedorn HG. Molecular evidence for tuberculosis in an ancient Egyptian mummy. Lancet. 1997; 350: 1404.
3
Miranda-Schaeubinger M, Venkatakrishna SSB, Otero HJ, Marais BJ, Goussard P, Frigati LJ, et al. Evolving role of chest radiographs for diagnosis of pediatric pulmonary tuberculosis. Pediatr Radiol. 2023; 53: 1753-64.
4
WHO. Global tuberculosis report 2013. 2013.
5
Leung AN. Pulmonary tuberculosis: the essentials. Radiology. 1999; 210: 307-22.
6
Jeong YJ, Lee KS. Pulmonary tuberculosis: up-to-date imaging and management. AJR Am J Roentgenol. 2008; 191: 834-44.
7
Bhalla AS, Goyal A, Guleria R, Gupta AK. Chest tuberculosis: radiological review and imaging recommendations. Indian J Radiol Imaging. 2015; 25: 213-25.
8
Skoura E, Zumla A, Bomanji J. Imaging in tuberculosis. Int J Infect Dis. 2015; 32: 87-93.
9
Rozenshtein A, Hao F, Starc MT, Pearson GD. Radiographic appearance of pulmonary tuberculosis: dogma disproved. A JR Am J Roentgenol. 2015; 204: 974-8.
10
Jones BE, Young SM, Antoniskis D, Davidson PT, Kramer F, Barnes PF. Relationship of the manifestations of tuberculosis to CD4 cell counts in patients with human immunodeficiency virus infection. Am Rev Respir Dis. 1993; 148: 1292-7.
11
Post FA, Wood R, Pillay GP. Pulmonary tuberculosis in HIV infection: radiographic appearance is related to CD4+ T-lymphocyte count. Tuber Lung Dis. 1995; 76: 518-21.
12
WHO. WHO consolidated guidelines on tuberculosis: module 5: management of tuberculosis in children and adolescents. 2022.
13
Concepcion NDP, Laya BF, Andronikou S, Abdul Manaf Z, Atienza MIM, Sodhi KS. Imaging recommendations and algorithms for pediatric tuberculosis: part 1-thoracic tuberculosis. Pediatr Radiol. 2023; 53:1773-81.
14
Buonsenso D, Pata D, Visconti E, Cirillo G, Rosella F, Pirronti T, et al. Chest CT scan for the diagnosis of pediatric pulmonary TB: radiological findings and its diagnostic significance. Front Pediatr. 2021; 9: 583197.
15
Mahomed N, Kilborn T, Smit EJ, Chu WCW, Young CYM, Koranteng N, et al. Tuberculosis revisted: classic imaging findings in childhood. Pediatr Radiol. 2023; 53: 1799-828.
16
Palmer M, Seddon J, Goussard P, Schaaf H, editors. Diagnostic CXR atlas for tuberculosis in children. A guide to chest X-ray interpretation. International Union Against Tuberculosis and Lung Disease: The Union; 2022.
17
Leung AN, Müller NL, Pineda PR, FitzGerald JM. Primary tuberculosis in childhood: radiographic manifestations. Radiology. 1992; 182: 87-91.
18
Andronikou S, Joseph E, Lucas S, Brachmeyer S, Du Toit G, Zar H, et al. CT scanning for the detection of tuberculous mediastinal and hilar lymphadenopathy in children. Pediatr Radiol. 2004; 34: 232-6.
19
Güneş A, Haliloğlu M. Çocukluk çağı tüberkülozunda radyolojik bulgular. Özçelik U KE, Ersu R, Gürkan F, editör. Çocukluk çağında tüberküloz tanı: tedavi ve korumada güncel yaklaşımlar ve olgu örnekleri. İstanbul: Nobel Tıp Kitabevleri; 2017.s.51-60.
20
Pillay T, Zar HJ, Venkatakrishna SSB, Andronikou S. Fast magnetic resonance imaging for diagnosing pulmonary tuberculosis in children: the sub-10-min unenhanced scan. Pediatr Radiol. 2024; 54: 425-9.
21
Wetscherek MTA, Sadler TJ, Lee JYJ, Karia S, Babar JL. Active pulmonary tuberculosis: something old, something new, something borrowed, something blue. Insights Imaging. 2022; 13: 3.
22
Marchiori E, Zanetti G, Barreto MM, de Andrade FT, Rodrigues RS. Atypical distribution of small nodules on high resolution CT studies: patterns and differentials. Respir Med. 2011; 105: 1263-7.
23
Kosaka N, Sakai T, Uematsu H, Kimura H, Hase M, Noguchi M, et al. Specific high-resolution computed tomography findings associated with sputum smear-positive pulmonary tuberculosis. J Comput Assist Tomogr. 2005; 29: 801-4.
24
Heo JN, Choi YW, Jeon SC, Park CK. Pulmonary tuberculosis: another disease showing clusters of small nodules. AJR Am J Roentgenol. 2005; 184: 639-42.
25
Alshoabi SA, Almas KM, Aldofri SA, Hamid AM, Alhazmi FH, Alsharif WM, et al. The diagnostic deceiver: radiological pictorial review of tuberculosis. Diagnostics (Basel). 2022; 12: 306.
26
Laya BF, Concepcion NDP, Andronikou S, Abdul Manaf Z, Atienza MIM, Sodhi KS. Imaging recommendations and algorithms for pediatric tuberculosis: part 2-extrathoracic tuberculosis. Pediatr Radiol. 2023; 53: 1782-98.
27
Synmon B, Das M, Kayal AK, Goswami M, Sarma J, Basumatary L, et al. Clinical and radiological spectrum of intracranial tuberculosis: a hospital based study in Northeast India. Indian J Tuberc. 2017; 64: 109-18.
28
Chiang SS, Khan FA, Milstein MB, Tolman AW, Benedetti A, Starke JR, et al. Treatment outcomes of childhood tuberculous meningitis: a systematic review and meta-analysis. Lancet Infect Dis. 2014; 14: 947-57.
29
Thwaites G, Fisher M, Hemingway C, Scott G, Solomon T, Innes J, et al. British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children. J Infect. 2009; 59: 167-87.
30
Andronikou S, Wieselthaler N. Modern imaging of tuberculosis in children: thoracic, central nervous system and abdominal tuberculosis. Pediatr Radiol. 2004; 34: 861-75.
31
Andronikou S, Smith B, Hatherhill M, Douis H, Wilmshurst J. Definitive neuroradiological diagnostic features of tuberculous meningitis in children. Pediatr Radiol. 2004; 34: 876-85.
32
Cherian A, Thomas SV. Central nervous system tuberculosis. Afr Health Sci. 2011; 11: 116-27.
33
Patkar D, Narang J, Yanamandala R, Lawande M, Shah GV. Central nervous system tuberculosis: pathophysiology and imaging findings. Neuroimaging Clin N Am. 2012; 22: 677-705.
34
van der Merwe DJ, Andronikou S, Van Toorn R, Pienaar M. Brainstem ischemic lesions on MRI in children with tuberculous meningitis: with diffusion weighted confirmation. Childs Nerv Syst. 2009; 25: 949-54.
35
Soni N, Kumar S, Shimle A, Ora M, Bathla G, Mishra P. Cerebrovascular complications in tuberculous meningitis—a magnetic resonance imaging study in 90 patients from a tertiary care hospital. Neuroradiol J. 2020; 33: 3-16.
36
Bernaerts A, Vanhoenacker F, Parizel P, Van Goethem J, Van Altena R, Laridon A, et al. Tuberculosis of the central nervous system: overview of neuroradiological findings. Eur Radiol. 2003; 13: 1876-90.
37
Andronikou S, Wieselthaler N, Smith B, Douis H, Fieggen AG, van Toorn R, et al. Value of early follow-up CT in paediatric tuberculous meningitis. Pediatr Radiol. 2005; 35: 1092-9.
38
Misra UK, Kalita J, Maurya PK. Stroke in tuberculous meningitis. J Neurol Sci. 2011; 303: 22-30.
39
DeLance AR, Safaee M, Oh MC, Clark AJ, Kaur G, Sun MZ, et al. Tuberculoma of the central nervous system. J Clin Neurosci. 2013; 20: 1333-41.
40
Mishra R, Shrivastava A, Raj S, Chouksey P. Intracranial tuberculomas and tubercular abscess-overcoming challenges. Neurology India. 2021; 69: 2-10.
41
Wasay M, Kheleani BA, Moolani MK, Zaheer J, Pui M, Hasan S, et al. Brain CT and MRI findings in 100 consecutive patients with intracranial tuberculoma. J Neuroimaging. 2003; 13: 240-7.
42
Luthra G, Parihar A, Nath K, Jaiswal S, Prasad K, Husain N, et al. Comparative evaluation of fungal, tubercular, and pyogenic brain abscesses with conventional and diffusion MR imaging and proton MR spectroscopy. AJNR Am J Neuroradiol. 2007; 28: 1332-8.
43
Srivastava T, Kochar D. Asymptomatic spinal arachnoiditis in patients with tuberculous meningitis. Neuroradiology. 2003; 45: 727-9.
44
Theron S, Andronikou S, Grobbelaar M, Steyn F, Mapukata A, du Plessis J. Localized basal meningeal enhancement in tuberculous meningitis. Pediatr Radiol. 2006; 36: 1182-5.
45
Marais S, Pepper DJ, Marais BJ, Török ME. HIV-associated tuberculous meningitis-diagnostic and therapeutic challenges. Tuberculosis. 2010; 90: 367-74.
46
Hosalkar HS, Agrawal N, Reddy S, Sehgal K, Fox EJ, Hill RA. Skeletal tuberculosis in children in the Western world: 18 new cases with a review of the literature. J Child Orthop. 2009; 3: 319-24.
47
Teo EL, Peh WC. Imaging of tuberculosis of the spine. Singapore Med J. 2004; 45: 439-44; quiz 445.
48
Morris B, Varma R, Garg A, Awasthi M, Maheshwari M. Multifocal musculoskeletal tuberculosis in children: appearances on computed tomography. Skeletal Radiol. 2002; 31: 1-8.
49
Desai S. Early diagnosis of spinal tuberculosis by MRI. J Bone Joint Surg Br. 1994; 76: 863-9. http[CrossRef]
50
Andronikou S, Jadwat S, Douis H. Patterns of disease on MRI in 53 children with tuberculous spondylitis and the role of gadolinium. Pediatr Radiol. 2002; 32: 798-805.
51
Lee KY. Comparison of pyogenic spondylitis and tuberculous spondylitis. Asian Spine Journal. 2014; 8: 216.
52
Chapman M, Murray RO, Stoker DJ. Tuberculosis of the bones and joints. Semin Roentgenol. 1979; 14: 266-82.
53
Prasad A, Manchanda S, Sachdev N, Baruah BP, Manchanda V. Imaging features of pediatric musculoskeletal tuberculosis. Pediatr Radiol. 2012; 42: 1235-49.
54
De Backer AI, Vanhoenacker FM, Sanghvi DA. Imaging features of extraaxial musculoskeletal tuberculosis. Indian J Radiol Imaging. 2009; 19: 176-86.
55
Hamijoyo L. Tuberculous arthritis: an overview. Indonesian Journal of Rheumatology. 2010; 2: 10-4.
56
Moore SL, Rafii M. Imaging of musculoskeletal and spinal tuberculosis. Radiol Clin North Am. 2001; 39: 329-42.
57
Prakash J, Mehtani A. Hand and wrist tuberculosis in paediatric patients-our experience in 44 patients. J Pediatr Orthop B. 2017; 26: 250-60.
58
Choi JA, Koh SH, Hong SH, Koh YH, Choi JY, Kang HS. Rheumatoid arthritis and tuberculous arthritis: differentiating MRI features. AJR Am J Roentgenol. 2009; 193: 1347-53.
59
Raut AA, Naphade PS, Ramakantan R. Imaging spectrum of extrathoracic tuberculosis. Radiol Clin North Am. 2016; 54: 475-501.
60
Agarwal A, Khan SA, Qureshi NA. Multifocal osteoarticular tuberculosis in children. J Orthop Surg (Hong Kong). 2011; 19: 336-40.
61
Lal SB, Bolia R, Menon JV, Venkatesh V, Bhatia A, Vaiphei K, et al. Abdominal tuberculosis in children: a real-world experience of 218 cases from an endemic region. JGH Open. 2019; 4: 215-20.
62
Tinsa F, Essaddam L, Fitouri Z, Brini I, Douira W, Ben Becher S, et al. Abdominal tuberculosis in children. J Pediatr Gastroenterol Nutr. 2010; 50: 634-8.
63
Delisle M, Seguin J, Zeilinski D, Moore DL. Paediatric abdominal tuberculosis in developed countries: case series and literature review. Arch Dis Child. 2016; 101: 253-8.
64
Malik R, Srivastava A, Yachha SK, Poddar U, Lal R. Childhood abdominal tuberculosis: disease patterns, diagnosis, and drug resistance. Indian J Gastroenterol. 2015; 34: 418-25.
65
Karaosmanoglu AD, Onur MR, Sahani DV, Tabari A, Karcaaltincaba M. Hepatobiliary tuberculosis: imaging findings. AJR Am J Roentgenol. 2016; 207: 694-704.
66
Nerli RB, Kamat GV, Alur SB, Koura A, Vikram P, Amarkhed SS. Genitourinary tuberculosis in pediatric urological practice. J Pediatr Urol. 2008; 4: 299-303.
67
Cremin BJ. Radiological imaging of urogenital tuberculosis in children with emphasis on ultrasound. Pediatr Radiol. 1987; 17: 34-8.
68
Mapukata A, Andronikou S, Fasulakis S, McCulloch M, Grobbelaar M, Jee L. Modern imaging of renal tuberculosis in children. Australas Radiol. 2007; 51: 538-42.