The diagnosis of tuberculosis in the child's chest is easy when tubercle bacilli can be found in the sputum, when the roentgen-ray chest plates show markings similar to those of adult tuberculosis, or when physical signs similar to those heard in cases of adult pulmonary tuberculosis are found. But in such cases the diagnosis is made too late; the child will almost surely die.
There are many reports and much writing which, when boiled down, state that a combination of all or several of the following observations establishes the diagnosis of tuberculosis in a child: a tuberculin reaction; a roentgen-ray chest plate showing calcification and large lymph nodes, especially with heavy trunks; parasternal or intrascapular dulness, and a d'Espine sign extending below the third dorsal spine. If there is a history of exposure, a low grade fever, a rapid pulse and loss of weight, then the diagnosis is complete.
DUNHAM K. THE DIAGNOSIS OF TUBERCULOSIS IN THE CHILD'S CHEST. JAMA. 1927;89(17):1413–1414. doi:10.1001/jama.1927.02690170037011
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