Results of Differential Diagnostics of Reactive Lung Changes with Suspected Tuberculosis in Children

Objective: to study the possibilities of radiological method in differential diagnosis of pulmonary tuberculosis in children.

Material and methods. The study included 75 children, who were examined for suspected tuberculosis due to detection of pathological lung changes on radiological images in the absence of complaints and clinical picture of the disease in the period from 2016 to 2024. The ultrasound diagnostic method was used to check for the presence of an interstitial lung reaction.

Results. On radiograms and computed tomograms, foci, consolidation, various signs of changes in lung interstitial tissue were determined. In 97.3% of cases, the tuberculous etiology of the detected changes on radiological images was excluded. It is advisable to call such findings “reactive changes in lung tissue”. In case of etiology verification, the conclusion “reactive changes in lung tissue” is replaced by a specific diagnosis. These changes are detected with a high frequency during the period of seasonal acute respiratory viral infections. The mean duration of reactive lung changes in nonspecific inflammatory processes is 4±2 weeks. The diagnostic period may change in case of protracted or chronic processes of non-tuberculous etiology.

Conclusion. There are no specific radiographic differences between reactive changes of any etiology and the tuberculous inflammatory process. Comparative assessment of radiographic images over a period of 2 to 6 weeks allows excluding a short-term nonspecific inflammatory process, thereby reducing the range of differential diagnostics. A process that lasts more than 6 weeks requires either justification of the cause, which should be reflected in the radiographic protocol, or introduction of alternative diagnostic methods with determination of the cause of the disease protraction. Both cases imply a completely different approach to patient management tactics. A radiographic picture of lung changes, which remains without image dynamics for more than 6 weeks, with a significant degree of probability, should be assessed as a process that is either inactive, or post-inflammatory, or tuberculous. Radiological signs of such changes may be similar, but patient management tactics are different.

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