Tracheobronchial tuberculosis

Abstract

Tracheobronchial tuberculosis (TBTB) is reported in approximately 10% to 39% of the patients with pulmonary tuberculosis. It is defined as the tubercle infection of the trachea and or bronchi. Due to its non-specific presentation, insidious onset and normal chest radiography in about 10-20% of the patients, the diagnosis is delayed. Bronchoscopy is the most definite method of diagnosis which provides adequate specimens for microbiological and histopathological diagnosis. Tracheobronchial stenosis is one of the most common long term complications of TBTB resulting in significant morbidity. It is estimated that 90% of patients with TBTB have some degree of tracheal and or bronchial stenosis. In this review article, we will discuss the pathogenesis, symptoms, imaging, bronchoscopic findings, and treatment of TBTB and management of tracheobronchial stenosis.

Keywords: Tuberculosis induced stenosis; bronchial stenosis; endobronchial stenosis; endobronchial tuberculosis; tracheobronchial stenosis; tracheobronchial tuberculosis (TBTB).

Figure 1

A 33-year-old South Korean female with history of treated TB, with 10 years diagnosis of asthma. (A) Flow volume loop with moderate flattening of the inspiratory and marked flattening of the expiratory limb; (B) distal tracheal stenosis with airway diameter of 8 mm; (C) right and left main stem bronchi stenosis measured 2.8 and 5.5 respectively.

Figure 2

A 30-year-old female post multi drug treatments for pulmonary tuberculosis with persistent wheezing. (A,B) Long severe stenosis of the left main stem bronchus of chest CT scan with virtual bronchoscopy; (C) bronchoscopic view of left main stem stenosis; (D) airway patency obtained following airway dilation and silicone stent placement.