1
|
Benhoumad O, Oulghoul O, Rochd S, Rochdi Y, Raji A. Endobronchial Tuberculosis Simulating Acute Foreign Body Inhalation: A Case Report. Indian J Otolaryngol Head Neck Surg 2022; 74:5657-5659. [PMID: 36742561 PMCID: PMC9895328 DOI: 10.1007/s12070-021-02985-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/08/2021] [Indexed: 02/07/2023] Open
Abstract
Endobronchial tuberculosis is a rare form of pulmonary tuberculosis, that can be due to the rupture of an infected lymph node through bronchial wall or lymphatic spread to the lining of the bronchial tree. Clinical presentation is non-specific, and can simulate inhalation of a foreign body. Otolaryngologists should be aware of its presentation often atypical. The following case is an unusual presentation of endobronchial tuberculosis in a 23-month-old patient initially diagnosed as a foreign body in the respiratory tract with acute dyspnea with unilateral wheezing and suspected foreign body on chest computed tomography. Bronchoscopy revealed a granulomatous mass in carina and both primary bronchi. Granuloma ablation improved patient's respiratory status. The pathology revealed an epithelioid and gigantic cellular with caseous necrosis compatible with tuberculosis. This unusual presentation of tuberculosis should be known to otolaryngologists and pediatricians in view of the frequency of tuberculosis in our context as well as increase in its incidence.
Collapse
Affiliation(s)
- Othmane Benhoumad
- Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
| | - Omar Oulghoul
- Faculty of Medicine and Pharmacy, CADI AYYAD University, Marrakech, Morocco
| | - Sara Rochd
- ENT-HNS Department, Mohammed VI University Hospital Center, Marrakech, Morocco
- Faculty of Medicine and Pharmacy, CADI AYYAD University, Marrakech, Morocco
| | - Youssef Rochdi
- Faculty of Medicine and Pharmacy, CADI AYYAD University, Marrakech, Morocco
| | - Abdelaziz Raji
- Faculty of Medicine and Pharmacy, CADI AYYAD University, Marrakech, Morocco
| |
Collapse
|
2
|
García-Martínez L, Laín Fernández A, Iglesias-Serrano I, Giné Prades C, Soriano-Arandes A, López M. Endobronchial tuberculosis in children: Defining the role of interventional bronchoscopy. Pediatr Pulmonol 2022; 57:2688-2695. [PMID: 35950618 DOI: 10.1002/ppul.26084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 06/07/2022] [Accepted: 07/16/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Endobronchial tuberculosis (EBTB) can lead to bronchopulmonary complications when diagnosis is delayed. Bronchoscopic treatment in children can be challenging due to small airway size. We report our experience treating children with EBTB. METHODS Retrospective study (2014-2020) of patients diagnosed with EBTB. Flexible bronchoscopy (FB) was performed in patients with previous diagnosis of pulmonary tuberculosis (PTB), after respiratory/radiological worsening was observed in spite of medical treatment. Treatment consisted in oral corticotherapy in all patients, and interventional bronchoscopy in selected cases. Our aim is to describe the endoscopic findings, interventional bronchoscopy alternatives, and outcome. RESULTS Of 45 patients with PTB, 13 (28.9%, 7 M/6 F) were diagnosed with EBTB, with a mean age of 3.9 years (0.4-12.8). Four bronchoscopic patterns were observed. Endobronchial granuloma (N:9; 69.2%): Excision with rigid bronchoscopy was achieved in five (1-5 procedures per patient), while corticotherapy alone was preferred in the remaining four due to small size/distal location of the granuloma. Caseum obstruction (2; 15.4%): dense mucous molds were removed with flexible/rigid bronchoscopy (6 and 8 procedures, respectively). Bronchial stenosis (1; 7.7%): two balloon dilatations with mitomycin-C application were performed. Extrinsic compression (1; 7.7%): oral corticotherapy alone was initiated. One patient developed bronchoscopy-related complications (pneumothorax requiring thoracic tube 48 h). With a medium follow-up of 4.6 years (1.8-7.6), three patients developed bronchiectasis while the remaining 10 improved clinically and radiologically. CONCLUSION Bronchoscopic findings in EBTB include granuloma, stenosis, caseum obstruction and external compression. In selected cases, interventional bronchoscopy can minimize long-term bronchopulmonary complications.
Collapse
Affiliation(s)
- Laura García-Martínez
- Pediatric Surgery Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ana Laín Fernández
- Pediatric Surgery Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ignacio Iglesias-Serrano
- Pediatric Respiratory Medicine Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Carles Giné Prades
- Pediatric Surgery Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Antoni Soriano-Arandes
- Paediatric Infectious Diseases and Immunodeficiencies Departament, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Manuel López
- Pediatric Surgery Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| |
Collapse
|
3
|
Guibert N, Héluain V, Brindel A, Plat G, Dutau H. Prothèses des voies aériennes : état de l’art. Rev Mal Respir 2022; 39:477-485. [DOI: 10.1016/j.rmr.2022.02.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/13/2022] [Indexed: 12/17/2022]
|
4
|
Guibert N, Saka H, Dutau H. Airway stenting: Technological advancements and its role in interventional pulmonology. Respirology 2020; 25:953-962. [PMID: 32162394 DOI: 10.1111/resp.13801] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/11/2020] [Accepted: 02/23/2020] [Indexed: 12/17/2022]
Abstract
AS offers rapid and sustained relief of symptoms in most patients treated for malignant or benign CAO and can also be curative in itself in cases of benign tracheobronchial stenosis. In the past 30 years, this field has seen significant progress, from the misuse of vascular non-covered metallic stents to the development of silicone airway stents with an increasingly large panel of shapes and of hybrid, partially or fully covered, SEMS customized to the airways. This study aims to offer an overview on: (i) the respective advantages and drawbacks of these two main categories of devices; (ii) the main indications for AS and the rationale behind the choice of stent in each situation; and (iii) the main promises borne from the progress made in the field in the past few years, including the development of drug-eluting, biodegradable or patient-specific customized AS.
Collapse
Affiliation(s)
- Nicolas Guibert
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Hideo Saka
- Department of Respiratory Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Hervé Dutau
- Thoracic Oncology, Pleural Disease and Interventional Pulmonology Department, North University Hospital, Marseille, France
| |
Collapse
|
5
|
Incidence, Etiology, and Clinicopathologic Features of Endobronchial Benign Lesions: A 10-Year Consecutive Retrospective Study. J Bronchology Interv Pulmonol 2018; 25:118-124. [PMID: 29346250 DOI: 10.1097/lbr.0000000000000460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Airways can be affected by non-neoplastic lesions leading to critical stenosis of the lumen. Incidence, etiology, and clinical significance of endobronchial benign lesions are not systematically characterized.This study aimed to assess the epidemiology of nonmalignant processes involving the bronchial tree on clinical, pathologic, endoscopic, and radiologic grounds. METHODS We retrospectively analyzed bronchoscopy procedures over 10 years at the Bronchoscopy Unit of Modena University Hospital. All the endoscopically growing benign lesions with histologic confirmation were considered. For each lesion, we evaluated demographics, clinical features and outcome, the endoscopic aspect and radiologic characteristics by means of computed tomography as assessed by 2 experienced radiologists blinded with regard to the diagnosis. RESULTS Over the study period, we analyzed 10,431 bronchoscopies and identified 2075 cases of tracheobronchial alterations. Among these, 11.2% had a benign etiology with an average annual incidence of 23 new cases/year and a general incidence of 2.2%. Anthrachosis was the most prevalent bronchial lesion. In total, 22% of benign lesions presented airway stenosis >50% and required bronchoscopic treatment. Bronchial stenosis was most frequently observed in tuberculosis (P=0.031) and aspergillosis (P=0.020) when compared with sarcoidosis. Immunosuppressive status was significantly associated with endobronchial aspergillosis (P=0.0001) and the 1-year survival from diagnosis resulted significantly lower irrespectively to the immune system condition. CONCLUSIONS A consistent proportion of endobronchial benign lesions are reported. One fifth of these are associated with critical stenosis of the airway lumen, requiring rigid bronchoscopy. Among these, aspergillosis is characterized by the poorest prognosis, regardless of host immunity status.
Collapse
|
6
|
Snene H, Ben Mansour A, Toujani S, Ben Salah N, Mjid M, Ouahchi Y, Mehiri N, Beji M, Cherif J, Louzir B. [Tuberculous pseudotumour, a challenging diagnosis]. Rev Mal Respir 2018; 35:295-304. [PMID: 29627293 DOI: 10.1016/j.rmr.2017.03.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 03/13/2017] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The pseudotumorous form of tuberculosis is a rare entity. Whatever its location, it can simulate neoplasia by its radiological and/or endoscopic appearances. We highlight the diagnostic difficulties associated with this type of presentation. METHODS We performed a retrospective study of inpatient records from 2003 to 2016 in the pneumology department of La Rabta Hospital to identify cases of thoracic tuberculous pseudo-tumor. RESULTS Seventeen patients were identified. The median age was 41 years and their symptomatology was dominated by cough and general debility. All had abnormal radiology with 10 cases of suspect lesions. Fibre-optic bronchoscopy revealed endobronchial abnormalities in 11 cases. The median overall diagnostic delay was 97 days. The diagnosis was confirmed bacteriologically in five cases, histologically in 14 cases and based on clinical presumption in one case. The progression was favourable: 13 patients have been declared cured and four patients are still undergoing treatment. CONCLUSION Making a positive diagnosis of thoracic tuberculous pseudotumour can be difficult, as bacteriological samples are often negative. This can lead to a significant delay in diagnosis and treatment.
Collapse
Affiliation(s)
- H Snene
- Université de Tunis El Manar, faculté de Médecine de Tunis, CHU Mongi Slim, service de pneumologie allergologie (unité de recherche 12SP06), La Marsa, Tunisie.
| | - A Ben Mansour
- Université de Tunis El Manar, faculté de médecine de Tunis, CHU La Rabta, service de pneumologie allergologie (unité de recherche 12SP06), Tunis, Tunisie
| | - S Toujani
- Université de Tunis El Manar, faculté de médecine de Tunis, CHU La Rabta, service de pneumologie allergologie (unité de recherche 12SP06), Tunis, Tunisie
| | - N Ben Salah
- Université de Tunis El Manar, faculté de Médecine de Tunis, CHU Mongi Slim, service de pneumologie allergologie (unité de recherche 12SP06), La Marsa, Tunisie
| | - M Mjid
- Université de Tunis El Manar, faculté de médecine de Tunis, CHU La Rabta, service de pneumologie allergologie (unité de recherche 12SP06), Tunis, Tunisie
| | - Y Ouahchi
- Université de Tunis El Manar, faculté de médecine de Tunis, CHU La Rabta, service de pneumologie allergologie (unité de recherche 12SP06), Tunis, Tunisie
| | - N Mehiri
- Université de Tunis El Manar, faculté de Médecine de Tunis, CHU Mongi Slim, service de pneumologie allergologie (unité de recherche 12SP06), La Marsa, Tunisie
| | - M Beji
- Université de Tunis El Manar, faculté de médecine de Tunis, CHU La Rabta, service de pneumologie allergologie (unité de recherche 12SP06), Tunis, Tunisie
| | - J Cherif
- Université de Tunis El Manar, faculté de médecine de Tunis, CHU La Rabta, service de pneumologie allergologie (unité de recherche 12SP06), Tunis, Tunisie
| | - B Louzir
- Université de Tunis El Manar, faculté de Médecine de Tunis, CHU Mongi Slim, service de pneumologie allergologie (unité de recherche 12SP06), La Marsa, Tunisie
| |
Collapse
|
7
|
Pecoul T, Barazzutti H, Vasse M, Berard H, Bylicki O. [An endobronchial fistula revealing tuberculosis: Atypical presentation in France]. REVUE DE PNEUMOLOGIE CLINIQUE 2017; 73:276-279. [PMID: 29054713 DOI: 10.1016/j.pneumo.2017.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 07/28/2017] [Accepted: 08/16/2017] [Indexed: 06/07/2023]
Affiliation(s)
- T Pecoul
- Service de pneumologie, hôpital d'instruction-des-armées-Saint-Anne, 83000 Toulon, France; École du Val-de-Grace, 75000 Paris, France
| | - H Barazzutti
- Service de pneumologie, hôpital d'instruction-des-armées-Saint-Anne, 83000 Toulon, France
| | - M Vasse
- École du Val-de-Grace, 75000 Paris, France; Service de chirurgie thoracique, hôpital d'instruction-des-armées-Sainte-Anne, 83000 Toulon, France
| | - H Berard
- Service de pneumologie, hôpital d'instruction-des-armées-Saint-Anne, 83000 Toulon, France
| | - O Bylicki
- Service de pneumologie, hôpital d'instruction-des-armées-Percy, 92140 Clamart, France.
| |
Collapse
|
8
|
Abstract
Endobronchial tuberculosis (EBTB) is a tuberculous infection of the tracheobronchial tree with microbial and histopathological evidence. Patients may present with symptoms secondary to disease itself or from the complication of disease like endobronchial obstruction. Diagnosis requires a high index of suspicion. Computed tomography (CT) and bronchoscopy along with microbiological investigations are the most useful diagnostic tools for the confirmation as well as for the evaluation of the tracheobronchial stenosis. The goals of treatment are eradication of tubercle bacilli with anti-tubercular medications and the prevention of airway stenosis. Interventional Bronchoscopic techniques and surgery is required for those patients who develop severe tracheobronchial stenosis that causing significant symptoms including dyspnea, repeated post obstructive pneumonia or bronchiectasis.
Collapse
Affiliation(s)
- Talha Shahzad
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Irfan
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| |
Collapse
|
9
|
Mechanical complication of endobronchial tuberculosis. Respir Med Case Rep 2016; 16:128-30. [PMID: 26744678 PMCID: PMC4681979 DOI: 10.1016/j.rmcr.2015.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/14/2015] [Accepted: 08/17/2015] [Indexed: 11/20/2022] Open
Abstract
A 19-year-old Vietnamese lady was diagnosed with culture positive, left upper lobe pulmonary tuberculosis for which medical treatment was initiated. Four months into treatment, she developed a 'rubber-band-like' stretching sensation in her left chest with wheezing and shortness of breath. Decreased respiratory excursion over the left lung was present on physical-examination. Chest-Xray revealed left-upper-lobe collapse with leftward deviation of the trachea and mediastinum. CT thorax revealed a long segment of stenosis in the left mainstem bronchus. FEV1 was 1.26 L (45% predicted), FVC 1.53 L (49% predicted), FEV1/FVC 82% (95% predicted) indicating airway limitation. Ventilation-perfusion scan noted 9.8% ventilation to the left lung and 92.8% to the right lung and 7.6% perfusion to the left lung and 92.4% to the right lung. Bronchoscopy was notable for pin point stenosis of the left mainstem bronchus beyond which was inflamed mucosa and abnormal cartilage rings in the left upper and middle lobe bronchi. Nine months of medical therapy for tuberculosis along with oral steroid taper was completed successfully; however the patient has required six serial bronchscopies with dilatations without stent placement at four to six week intervals due to partial restenosis, with the last bronchoscopy at four months after completion of tuberculosis therapy.
Collapse
|
10
|
Abstract
Endobronchial tuberculosis has a very varied presentation. Diagnosis is often very challenging as typical radiological features are absent and sputum smear for acid-fast bacilli is often negative. However, detection is essential as it may lead to long-term sequelae such as bronchial stenosis. Bronchoscopy is a very useful investigation in such cases. Our case is a rare manifestation of endobronchial tuberculosis as it mimicked malignancy.
Collapse
Affiliation(s)
- Shahid M Patel
- Department of Pulmonary Medicine, Padmashree Dr. DY Patil Hospital, Navi Mumbai, Maharashtra, India
| | - Aparna Iyer
- Department of Pulmonary Medicine, Padmashree Dr. DY Patil Hospital, Navi Mumbai, Maharashtra, India
| | - T K Jayalakshmi
- Department of Pulmonary Medicine, Padmashree Dr. DY Patil Hospital, Navi Mumbai, Maharashtra, India
| | - Girija Nair
- Department of Pulmonary Medicine, Padmashree Dr. DY Patil Hospital, Navi Mumbai, Maharashtra, India
| |
Collapse
|
11
|
Kwong Y, Naidoo P. Images in emergency medicine. Elderly woman with shortness of breath. Endobronchial tuberculosis. Ann Emerg Med 2015; 65:714-5. [PMID: 26014219 DOI: 10.1016/j.annemergmed.2014.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 07/01/2014] [Accepted: 07/07/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Yune Kwong
- Monash Health, Clayton, Victoria, Australia
| | | |
Collapse
|
12
|
Critchley JA, Orton LC, Pearson F. Adjunctive steroid therapy for managing pulmonary tuberculosis. Cochrane Database Syst Rev 2014; 2014:CD011370. [PMID: 25387839 PMCID: PMC6532561 DOI: 10.1002/14651858.cd011370] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Tuberculosis causes approximately 8.6 million disease episodes and 1.3 million deaths worldwide per year. Although curable with standardized treatment, outcomes for some forms of tuberculosis are improved with adjunctive corticosteroid therapy. Whether corticosteroid therapy would be beneficial in treating people with pulmonary tuberculosis is unclear. OBJECTIVES To evaluate whether adjunctive corticosteroid therapy reduces mortality, accelerates clinical recovery or accelerates microbiological recovery in people with pulmonary tuberculosis. SEARCH METHODS We identified studies indexed from 1966 up to May 2014 by searching: Cochrane Infectious Diseases Group's trials register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and LILACS using comparative search terms. We handsearched reference lists of all identified studies and previous reviews and contacted relevant researchers, organizations and companies to identify grey literature. SELECTION CRITERIA Randomized controlled trials and quasi-randomized control trials of recognized antimicrobial combination regimens and corticosteroid therapy of any dose or duration compared with either no corticosteroid therapy or placebo in people with pulmonary tuberculosis were included. DATA COLLECTION AND ANALYSIS At least two investigators independently assessed trial quality and collected data using pre-specified data extraction forms. Findings were reported as narrative or within tables. If appropriate, Mantel-Haenszel meta-analyses models were used to calculate risk ratios. MAIN RESULTS We identified 18 trials, including 3816 participants, that met inclusion criteria. When compared to taking placebo or no steroid, corticosteroid use was not shown to to reduce all-cause mortality, or result in higher sputum conversion at 2 months or at 6 months (mortality: RR 0.77, 95%CI 0.51 to 1.15, 3815 participants, 18 studies, low quality evidence; sputum conversion at 2 months RR 1.03, 95%CI 0.97 to 1.09, 2750 participants, 12 studies; at 6 months; RR1.01, 95%CI 1.01, 95%CI 0.98 to 1.04, 2150 participants, 9 studies, both low quality evidence). However, corticosteroid use was found to increase weight gain (data not pooled, eight trials, 1203 participants, low quality evidence), decrease length of hospital stay (data not pooled, three trials, participants 379, very low quality of evidence) and increase clinical improvement within one month (RR 1.16, 95% CI 1.09 to 1.24; five trials, 497 participants, low quality evidence). AUTHORS' CONCLUSIONS It is unlikely that adjunctive corticosteroid treatment provides major benefits for people with pulmonary tuberculosis. Short term clinical benefits found did not appear to be maintained in the long term. However, evidence available to date is of low quality. In order to evaluate whether adjunctive corticosteroids reduce mortality, or accelerate clinical or microbiological recovery in people with pulmonary tuberculosis further large randomized control trials sufficiently powered to detect changes in such outcomes are needed.
Collapse
Affiliation(s)
- Julia A Critchley
- St George's, University of LondonPopulation Health Sciences InstituteCranmer TerraceLondonUKSW17 0RE
| | - Lois C Orton
- University of LiverpoolSchool of Population, Community and Behavioural SciencesDivision of Public HealthWhelan Building, Brownlow HillLiverpoolUKL69 3GB
| | - Fiona Pearson
- St George's, University of LondonPopulation Health Sciences InstituteCranmer TerraceLondonUKSW17 0RE
| | | |
Collapse
|
13
|
Analysis of the surgical treatment of endobronchial tuberculosis (EBTB). Surg Today 2014; 44:1434-7. [PMID: 24733112 DOI: 10.1007/s00595-014-0865-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 07/18/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE Endobronchial tuberculosis (EBTB) is defined as tuberculosis infection of the tracheobronchial tree. EBTB may require aggressive treatment, including lung resection, because of severe bronchostenosis and its complications, despite formal anti-TB chemotherapy. We present our experience of treating 25 patients with EBTB. METHODS We reviewed retrospectively the medical records of 25 patients with EBTB treated between 2002 and 2012 at the Department of Thoracic Surgery in Beijing Chest Hospital. RESULTS All 25 patients (5 male, 20 female) underwent surgery for fibrostenotic type EBTB. Bronchoscopy showed fibrostenotic change in all patients and a cough was the most common symptom. Postoperatively, all patients were given anti-TB therapy to take for 6-9 months. CONCLUSIONS EBTB tends to occur at a higher incidence in young women. Surgery may be required for severe bronchostenosis and its complications and should be performed for symptomatic fibrostenotic type EBTB. During the operation, attention should be paid to prevent severe complications and postoperative anti-TB therapy is mandatory.
Collapse
|
14
|
Nemati A, Safavi E, GhasemiEsfe M, Anaraki MZ, Firoozbakhsh S, Khalilzadeh O, Anvari M. Fistula formation between the right and left main bronchus caused by endobronchial tuberculosis. Am J Med Sci 2012; 343:330-1. [PMID: 22227512 DOI: 10.1097/maj.0b013e31823e612a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The prevalence of endobronchial tuberculosis (EBTB) in patients with active tuberculosis is about 10% to 40%. The most common complication of EBTB is bronchial stenosis. Fistula formation by pulmonary tuberculosis is a very rare complication and is most commonly bronchopleural. The authors present a 53-year-old woman presented with chronic cough and abnormality in chest computed tomography scan. According to chest computed tomography scan finding, bronchoscopic study was done and bronchial lavage was obtained. Bronchial lavage was positive for acid fast bacilli. Bronchoscopy showed fistula formation between the right and left main bronchus, a rare manifestation of EBTB. The patient was treated with antituberculosis therapy, and her symptoms improved and radiological findings showed regression of pulmonary lesions.
Collapse
Affiliation(s)
- Alireza Nemati
- Advanced Diagnostic and Interventional Thoracic Research Center, Imam Hospital, Tehran, Iran
| | | | | | | | | | | | | |
Collapse
|
15
|
Abstract
BACKGROUND In this study, our aim was to determine the clinical and bronchoscopic outcome of the endobronchial tuberculosis (ETB). METHODS Patients with suspected tuberculosis (TB) or TB patients with an inadequate response to 8 weeks of antituberculosis treatment were enrolled in the study. RESULTS Seventy patients were included to the study and 118 flexible bronchoscopies were performed. ETB was present in 33 (47%) patients. There was isolated compression in 14 cases, caseous lesions in 13, granuloma formation in 6, polypoid lesions in 2, adenopathy protrusion in 1, and mucosal erosion in 1 case. The mean duration of bronchoscopic resolution of endobronchial lesions was 5.50 +/- 2.74 months. Mycobacterium tuberculosis was isolated from gastric lavage in 10% and from bronchoalveolar lavage in 12.8% of 70 cases. When both of the procedures were performed concurrently, the isolation rate increased to 20%. Transient hypoxia resolving with nasal O2 was observed in 3 patients as a complication of bronchoscopy. CONCLUSIONS Bronchoscopy offered a safe and rapid means of confirming the diagnosis of ETB.
Collapse
|
16
|
Kim HC, Kim HS, Lee SJ, Jeong YY, Jeon KN, Lee JD, Hwang YS. Endobronchial tuberculosis presenting as right middle lobe syndrome: clinical characteristics and bronchoscopic findings in 22 cases. Yonsei Med J 2008; 49:615-9. [PMID: 18729304 PMCID: PMC2615288 DOI: 10.3349/ymj.2008.49.4.615] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Endobronchial tuberculosis (EBTB) presenting as right middle lobe syndrome (RMLS) is an uncommon clinical condition. We investigated the clinical characteristics in patients with EBTB presenting as RMLS. PATIENTS AND METHODS We retrospectively reviewed the records of 22 patients with EBTB presenting as RMLS who were diagnosed at our hospital from 2003 to 2006. RESULTS Its occurrence was more common in females than males (F, 18; M, 4). The mean age was 70.3 +/- 8.5 years, and 17 patients were above the age of 65 years. Cough with sputum was the most common manifestation and 2 patients were asymptomatic. In bronchoscopic analysis, the most common finding was edematous-type EBTB, which was found in 15 patients, followed by actively caseating type in 6 and tumorous type in 1. Acid-fast bacilli (AFB) staining for bronchial washing fluid was positive in only 5 patients: 1 with edematous type and 4 with actively caseating type. Bronchoscopic biopsy showed chronic granulomatous inflammation in 16 patients. Follow-up chest X-ray after treatment showed complete disappearance of the lesion in 2 patients, more than 50% improvement in 5, less than 50% improvement in 5, and no change of lesion in 4. CONCLUSION Edematous-type EBTB was the most common type of EBTB presenting as RMLS, and it usually occurred in elderly patients. Culturing for mycobacterium and histologic examination by bronchoscopy are necessary for proper diagnosis in these patients.
Collapse
Affiliation(s)
- Ho Cheol Kim
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, 92 Chilam-dong, Jinju 660-751, Korea.
| | | | | | | | | | | | | |
Collapse
|
17
|
Cakir E, Gocmen B, Uyan ZS, Oktem S, Kiyan G, Karakoc F, Ersu R, Karadag B, Dagli T, Dagli E. An unusual case of chylothorax complicating childhood tuberculosis. Pediatr Pulmonol 2008; 43:611-4. [PMID: 18433047 DOI: 10.1002/ppul.20817] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Endobronchial tuberculosis (EBTB) and chylothorax are rare clinical disorders. The concurrence of these two disorders as manifestations of childhood pulmonary tuberculosis has not been reported. We report a 4-month-old boy presenting with chylothorax as the initial presentation of tuberculosis that has been successfully treated with octreotide, antituberculosis drugs and steroid therapy.
Collapse
Affiliation(s)
- Erkan Cakir
- Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Wong JSW, Ng CSH, Lee TW, Yim APC. Bronchoscopic management of airway obstruction in pediatric endobronchial tuberculosis. Can Respir J 2006; 13:219-21. [PMID: 16779468 PMCID: PMC2683283 DOI: 10.1155/2006/278680] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The present report describes a case of severe airway obstruction caused by endobronchial tuberculosis in an 11-year-old girl who was successfully treated by bronchoscopic balloon dilation. This case illustrates the insidious presentation and the increasingly important role of bronchoscopic intervention in the management of endobronchial tuberculosis. In addition, a brief literature review of the condition in the pediatric age group is included.
Collapse
Affiliation(s)
| | | | | | - Anthony PC Yim
- Correspondence: Dr Anthony PC Yim, Division of Cardiothoracic Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. Telephone 852-2632-2629, fax 852-2647-8273, e-mail
| |
Collapse
|
19
|
Agarwal S, Hong DK, Soslow J, Chang KW. Not your routine foreign body: endobronchial tuberculosis in an infant. Pediatrics 2005; 116:246-8. [PMID: 15995065 DOI: 10.1542/peds.2004-1904] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Foreign-body aspiration is a common cause of respiratory distress among children. Here we describe an 8-month-old, previously 34-week premature, male patient who presented with a 1-day history of fever and increased work of breathing. Of note, 3 weeks before presentation, the patient had been treated with orally administered amoxicillin for presumed pneumonia and exhibited good clinical response. No chest radiograph was obtained at that time. A current chest radiograph revealed hyperexpansion of the left lung, with a mediastinal shift. Although the patient was referred because of possible foreign-body aspiration, no clear history of an aspiration event was obtained, and computed tomographic scans of the chest were recommended. These showed extensive hilar and mediastinal lymphadenopathy, resulting in obstruction of the left bronchus. Bronchoscopy revealed a cheesy granulomatous mass in the left mainstem bronchus, which was ball-valving into the upper bronchus. Removal resulted in improvement of the patient's respiratory status. Pathology, bronchial lavage, and gastric aspirate specimens all revealed acid-fast bacilli, consistent with Mycobacterium tuberculosis infection. This unusual presentation of tuberculosis may become more common in the United States as the incidence of immigrants carrying tuberculosis increases.
Collapse
Affiliation(s)
- Swati Agarwal
- Department of Pediatrics, Lucile Packard Children's Hospital at Stanford University, 750 Welch Rd, Suite 315, Palo Alto, CA 94304, USA.
| | | | | | | |
Collapse
|