Abstract Rationale Evidence on pediatric necrotizing pneumonia (NP) caused by Mycobacterium tuberculosis (Mtb) is limited and largely confined to case reports. The largest earlier case series from South Africa (n = 32) found Mtb responsible for 25% of pediatric NP, with most cases occurring in HIV-infected children1. Vietnam ranks 13th globally for tuberculosis burden. Distinguishing Mtb-associated NP (Mtb-NP) from bacterial NP remains difficult, as pediatric sputum Xpert detects only 65% of cases. We aimed to describe chest computed tomography (CT) features of pediatric Mtb-NP in a high-burden setting to support clinical differentiation. Methods We conducted a retrospective descriptive case series of children aged 1 month-16 years with Mtb-NP admitted to Children’s Hospital 2, a tertiary referral center in Ho Chi Minh City, Vietnam, from January 2022 to August 2025. Results Among 146 hospitalized NP cases during the study period, 21 (14.4%) were diagnosed as Mtb-NP. Of these, 20 underwent chest CT and were included. Microbiologic confirmation was obtained in 6/20 (1 smear-positive, 1 culture-positive, 4 Xpert-positive); the remaining cases lacked microbiologic evidence but improved on anti-tuberculosis therapy. On chest CT, 67% exhibited both cavitary lesions and low-attenuation necrotic foci within areas of consolidation; 33% showed low-attenuation necrosis without cavitation. Necrosis was bilateral in 40% and confined to the right lung in 40%. The largest necrotic foci most often involved the right upper, right lower, and left lower lobes (each 27%). Pleural effusions occurred in 86% (similar left-right distribution); 7% were bilateral, and 62% of effusions were septated. Concomitant pneumothorax was present in 33%, bronchiectasis in 27%, and atelectasis in 33%. Lymphadenopathy was observed in all cases; median node size 15 mm IQR 12-18; 53% showed central nodal necrosis and 27% had nodal calcification. Conclusions Lymphadenopathy and pleural effusions are very common in pediatric Mtb-NP. Pulmonary involvement is rarely confined to the left lung. Central nodal necrosis was present in about half of cases. 1 Jacobs C., Goussard P., Gie R. P. Mycobacterium tuberculosis, a cause of necrotising pneumonia in childhood: a case series. International Journal of Tuberculosis and Lung Disease. 2018;22(6):614-616. This abstract is funded by: None
Cao et al. (Fri,) studied this question.