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\begin{document}

\title{A Proposed CT Classification of Progressive Lung Parenchymal Injury
Complicating Paediatric Lymphobronchial Tuberculosis -- from reversible
to irreversible lung injury}



\author[1]{Savvas Andronikou}%
\author[2]{Susan Lucas}%
\author[3]{Andrea Zouvani}%
\author[4]{Pierre Goussard}%
\affil[1]{The Children's Hospital of Philadelphia}%
\affil[2]{University of the Witwatersrand}%
\affil[3]{University of Glasgow}%
\affil[4]{Stellenbosch University}%


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  \date{May 17, 2024}


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\begin{abstract}
Abstract Lymphobronchial tuberculosis (LBTB) is tuberculous
lymphadenopathy affecting the airways, which is particularly common in
children with primary TB. Airway compression by lymphadenopathy causes
downstream parenchymal pathology, which may ultimately result in
irreversible lung destruction, if not treated timeously. CT is
considered the ``gold standard'' for detecting mediastinal lymph nodes
in children with TB. CT is also the best way of imaging the airways of
children with LBTB. The CT findings of the parenchymal complications and
associations of LBTB on CT have been described, but no severity
classification was provided to aid management decisions. Identifying the
parenchymal complications of LBTB and recognising their severity has
clinical relevance. Using prior publications on LBTB and post
obstructive lung injury we have used an image bank of CT scans in
children with pulmonary TB, presenting with airway symptoms, to create a
CT severity staging of lung injury in LBTB. The staging focuses on
distinguishing non-salvageable destruction {[}non-enhancing or cavitated
lung{]} from salvageable lung parenchymal disease {[}enhancing and
non-cavitated{]} to inform the management decisions, which range from
bronchoscopic airway clearance to surgical decompression of the
compressing nodes.%
\end{abstract}%



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