ПРИЧИНЫ РАЗНОНАПРАВЛЕННОЙ РЕНТГЕНОЛОГИЧЕСКОЙ ДИНАМИКИ ПРИ ЛЕЧЕНИИ ТУБЕРКУЛЕЗА ОРГАНОВ ДЫХАНИЯ У ДЕТЕЙ И ПОДРОСТКОВ

Abstract

Chest CT monitoring of children with TB is the principal method of evaluation of treatment effectiveness. Multidirectional CT dynamics at any stage of treatment requires a well-informed decision concerning further treatment tactics. Objective: To analyze possible causes and clinical significance of multidirectional dynamic changes in the lungs during treatment for pulmonary TB in children and adolescents. Materials and methods. A retrospective study: we analyzed inpatient case records and CT files of 49 patients aged 2–17 years with active pulmonary TB, who demonstrated multidirectional dynamic changes in the lungs during the main treatment course according to chest CT data. Non-contrast-enhanced CT with lung and abdominal windows at no more than 1.3 mm slice thickness was used. The dynamic changes were assessed using various radiological patterns and compared with clinical and laboratory data; the administered chemotherapy regimen was assessed considering drug susceptibility data from both patient and infection source. Results. Multidirectional CT dynamics was detected at various stages of TB treatment. The retrospective analysis showed that in 31% of cases it witnessed treatment failure and required treatment correction, in 47% of cases it demonstrated natural course of TB, in 9% of cases it was associated with concomitant pathology. We failed to determine the cause of multidirectional CT dynamics in 4% of cases, in these cases further treatment options were targeted to chemotherapy correction. Conclusion. Multidirectional CT dynamics during treatment for pulmonary TB in children and adolescents does not always mean treatment failure, other possible causes should be also considered.