Edward Y. Lee MD, MPH, Presenter: Nothing to Disclose

Donald A. Tracy MD, Abstract Co-Author: Nothing to Disclose

Ronald L. Eisenberg MD, JD, Abstract Co-Author: Nothing to Disclose

Claudia Martinez Rios Arellano MD, Abstract Co-Author: Nothing to Disclose

Soran A. Mahmood MD, Abstract Co-Author: Nothing to Disclose

Phillip M. Boiselle MD, Abstract Co-Author: Nothing to Disclose

Robert Harris Cleveland MD, Abstract Co-Author: Nothing to Disclose

David Zurakowski PhD, Abstract Co-Author: Nothing to Disclose

To determine whether a lateral chest radiograph provides additional diagnostic information to a posteroanterior (PA) radiograph in the screening of asymptomatic children with positive purified protein derivative (PPD) skin tests in a non-endemic area.

This was a retrospective study of 605 consecutive pediatric patients (294 males, 311 females; mean age, 10.8 years) with positive PPD skin test results, who underwent PA and lateral CXR in a non-endemic area for TB. Two pediatric radiologists independently reviewed each CXR for evidence of abnormalities that may be indicative of acute or chronic TB infection. The reviewers first analyzed the PA radiograph alone and subsequently evaluated the PA and the lateral radiograph together to determine whether any observed abnormality was identified only on the lateral radiograph. When an abnormality was detected on both PA and lateral CXR, the reviewers determined whether the abnormality on the lateral radiograph changed the reviewer’s decision based on the PA radiograph alone. Assessment of nonconcordance between PA and lateral CXR for each reviewer and agreement between reviewers for detecting abnormalities on radiographs were evaluated.

The frequency of an abnormal chest radiograph related to TB was 1.8% (11 / 605). The PA radiograph showed abnormalities in all 11 (100%) children with radiographic abnormalities. Nine (81.8%) of 11 abnormalities on PA radiographs were not detected on the lateral chest radiographs. There was statistical evidence of nonconcordance between PA and lateral chest radiographs in detecting TB- related abnormalities for reviewer 1 (P < .001) and reviewer 2 (P = .004). In cases with abnormalities observed on both PA and lateral radiographs, there were no cases in which information obtained from the lateral chest radiograph resulted in a change in interpretation based on the PA radiograph alone. A high level of agreement was observed between the two independent reviewers in detecting TB related abnormalities on PA radiographs (κ = 0.84, P < .001).

A PA radiograph alone is sufficient for TB screening of asymptomatic pediatric patients with positive PPD skin test results in an area non-endemic for TB.

The acquisition of a PA radiograph alone is sufficient to screen asymptomatic children with abnormal PPD skin test results in an area that is not endemic for TB.

Lee, E, Tracy, D, Eisenberg, R, Martinez Rios Arellano, C, Mahmood, S, Boiselle, P, Cleveland, R, Zurakowski, D, Screening of Asymptomatic Children for Tuberculosis: Is a Lateral Chest Radiograph Routinely Indicated?.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9012092.html