ORIGINAL ARTICLE Evaluation of Chest X-ray and Thoracic Computed Tomography in Patients with Suspected Tuberculosis Mehmet Sait Durmus 1,2 & Ismail Yildiz 1 & Murat Sutcu 1 & Muhammet Bulut 1 & Muhammet Ali Varkal 1 & Furkan Ubeydullah Ertem 1 & Ayse Kilic 1 & Fatma Oguz 1 & Emin Unuvar 1 & Ensar Yekeler 3 Received: 14 January 2015 /Accepted: 4 November 2015 # Dr. K C Chaudhuri Foundation 2015 Abstract Objective To investigate if there is any correlation between positive findings detected by posterior-anterior (PA) chest ra- diograph and thoracic computerized tomography (CT) in cases with suspected lung tuberculosis (TB) due to positive tuberculin skin test (TST) results. Methods This is a retrospective evaluation of the medi- cal files of patients who visited the Department of Pediatrics, Istanbul University, Istanbul Faculty of Medicine from 2006, through 2011 as outpatients and had positive TST (>15 mm) results. Results A total of 326 patients were included in the study; 45.7 % (n = 149) were girls, and the mean age was 9.0 ± 4.1 y (range: 1–17 y). In total, 14.4 % (n = 47) had TB findings, all of which were in the form of hilar lymphadenopathy. Among the 47 cases with TB findings in PA chest X-ray, 45 (95.7 %) also had findings in thoracic CT. Only 2 (4.3 %) patients had normal thoracic CT results although their PA chest X-ray re- sults were positive. Conclusions Evaluation for pulmonary TB in children with positive isolated TSTs should be made primarily with PA chest X-ray. A routine thoracic CT scan is not necessary for asymptomatic patients with only hilar lymphadenopathy find- ings in PA chest radiographs. Keywords Children . Chest X-ray . Tuberculosis . Tuberculin skin test . Radiology Introduction Tuberculosis (TB) is a highly prevalent disease worldwide that continues to be a significant cause of morbidity and mor- tality, especially in the developing countries. On clinical sus- picion of TB, tuberculin skin test (TST) and/or interferon – γ release assay (IGRA) are among the firstline tests in the diag- nostic work up of the patient. However their positivity cannot discriminate active TB infection from latent TB infection (LTBI) [1]. For adults with suspected TB, postero-anterior (PA) chest X-ray (CXR) is often the first preferred radiological evaluation. CXR and thoracic computerized tomography (CT) are effective radiological methods for identifying Mycobacterium tuberculosis infection in children. Up-to- date guidelines recommend CXR screening for excluding the possibility of pulmonary TB in asymptomatic children with positive TST/IGRA test. Thoracic CT is recommended for patients with suspicious CXR findings [2, 3]. However, recent studies report that CXR may be of limited value in detecting asymptomatic TB infection in adults [4]. The reli- ability of CXR is not clear for TB diagnosis among asymp- tomatic children with thoracic TB, and there are few studies conducted with children on this issue [5]. With thoracic CT, more detailed information is obtained regarding the presence and the extensity of thoracic TB, allowing identification of micronodules, nodules, masses, lymphadenopathy (LAP), consolidation, ground-glass opacities, etc. [6]. Differentiating LTBI from active TB disease is significant in determining the course of treatment. The active infection may be missed if CXR is used alone. On the other hand, * Mehmet Sait Durmus msaitdurmus@gmail.com 1 Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey 2 Merkez mah. Silahtaraga cad, No:73 Eyüp, Istanbul, Turkey 3 Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey Indian J Pediatr DOI 10.1007/s12098-015-1949-2