Clinical and imaging features in the differentiation of pediatric pulmonary tuberculosis and pneumonia

Objective To compare the clinical and Imaging characteristics between children with pediatric pulmonary tuberculosis (PTB) and children with pneumonia who were initially suspected of PTB, and to explore valuable indicators for differential diagnosis. Methods This retrospective study enrolled pediatric inpatients initially suspected of PTB at Guangzhou Chest Hospital from March 2020 to May 2021. All participants were divided into the PTB group and the control group. Clinical characteristics, laboratory results, and chest computed tomography (CT) imaging findings were compared between the two groups. On the basis of univariate analysis, variables were further screened via the least absolute shrinkage and selection operator (LASSO) regression with reference to clinical significance. A stable and reliable predictive model was finally established using Firth penalized logistic regression. Results A total of 63 children were enrolled in this study. Among them, 48 were finally diagnosed with PTB, including 23 cases with etiological confirmation and 25 cases with clinical diagnosis, which constituted the PTB group. The remaining 15 children were diagnosed with pneumonia and assigned to the control group. Compared with the control group, the PTB group had a significantly higher rate of tuberculosis contact history, longer pre-hospital symptom duration, and higher rates of pre-hospital antibiotic and systemic glucocorticoid use. In terms of chest CT manifestations, multiple pulmonary nodules, hilar/mediastinal/axillary lymphadenopathy, calcification, and fine linear or reticular opacities were significantly more common in the PTB group. The final predictive model was constructed based on the two most differentiating imaging features, namely multiple pulmonary nodules and hilar/mediastinal/axillary lymphadenopathy, and presented excellent diagnostic efficacy. The area under the receiver operating characteristic curve was 0.99. The corresponding sensitivity, specificity and overall accuracy were 93.75%, 100% and 95.24%, respectively. Conclusion This study preliminarily developed an imaging model based on multiple pulmonary nodules and hilar/mediastinal/axillary lymphadenopathy, which may assist in distinguishing pediatric PTB from pneumonia. However, given the single-center, specialized-hospital setting of this study and the exclusion of certain patient subgroups, the generalizability of these findings is limited. Therefore, the conclusions require validation through future multicenter, large-scale prospective studies.