Investigation of endobronchial tuberculosis diagnoses in 22 cases

Abstract

Background: Endobronchial tuberculosis (EBTB) is a special form of pulmonary tuberculosis. In spite of much progress in the diagnosis of this disease in past years, delayed or mistaken diagnosis is still commonly seen.

Objective: The aim of this study is to try to find out some useful clues for the diagnosis of EBTB, especially the early diagnosis.

Methods: The medical records of patients with EBTB were analyzed retrospectively.

Results: The male-to-female ratio was 1:2.2 out of 22 patients. Patients aged below 60-years-old constituted 72.7% of the cases. 22.7% of these patients were smokers. The male-to-female ratio of smokers was 4:1. 68.2% of these patients tested all showed negative result for the HIV test. The frequent complaints were cough, sputum, shortness of breath and fever, and antibiotic treatments were usually inefficacious. Multiple lobes lesion, exudative shadow and atelectasis were the frequent radiological findings. Acid-fast bacilli staining for sputum smear was positive in only 13.6% of these patients. Tuberculin skin test was positive in 59.1% of these patients. Granular lesion was the most common bronchoscopic appearance in these patients. Histological changes showed distinctive tuberculose lesion in 72.2% of 18 patients undergoing bronchoscopic biopsy.

Conclusion: The diagnosis of EBTB is easily delayed or mistaken because of nonspecific clinical manifestations and the low incidence of positive acid-fast bacilli staining. A high index of awareness of this disease is required for diagnosis. Bronchoscopy should be performed as soon as possible in suspected patients, especially when patients present positive tuberculin skin test or no response to antibiotic treatments.

Figure 1

Radiological findings showed varied pulmonary lesions in patients with EBTB. The left: sheeted exudative shadows and nodules in bilateral middle and lower lung fields. The middle: atelectasis of right lung. The right: exudative shadows in right lower lung field.

Figure 2

Computer tomography of a patient with EBTB showed the wall thickening of left upper bronchi (arrow) and exudative shadow in left upper lobe.

Figure 3

Bronchoscopic appearances of seven subtypes of EBTB. A: the actively caseating. B: The oedematous-hyperaemic. C: The fibrostenotic (arrow). D: The tumorous. E: The granular. F: The ulcerative (arrow). G: The nonspecific bronchitic.