Bronchial anthracofibrosis: The spectrum of radiological appearances

The Atypical Manifestation of Pulmonary Tuberculosis in Patients with Bronchial Anthracofibrosis

It has been stated that bronchial anthracofibrosis (BAF) has an important relationship with pulmonary tuberculosis (TB), and the coexistence of TB and BAF is high. The purpose of this study was to compare the differences in computed tomography (CT) characteristics of pulmonary TB according to the presence of underlying BAF. Total of 202 consecutive patients who were diagnosed with pulmonary TB and underwent bronchoscopy and CT in our institution were retrospectively reviewed. We classified the patients into two groups according to the presence of BAF and compared the clinicoradiological findings between the two groups (anthracofibrosis group vs. nonanthracofibrosis group). Elderly and female patients were significantly higher in anthracofibrosis group (mean age 79 ± 7 (64−94) vs. 56 ± 17 (16−95), p < 0.001; female 89% vs. 29%, p < 0.001). The frequency of internal low-density area or focal contour bulge within atelectasis (64% vs. 1%, p < 0.001), lower lobe predominance (43% vs. 9%, p < 0.001), endobronchial involvement (46% vs. 15%, p < 0.001), and lymphadenopathy (57% vs. 28%, p = 0.002) were significantly higher in anthracofibrosis group. In contrast, the anthracofibrosis group showed lower frequency of upper lobe predominance (32% vs. 81%, p < 0.001) and cavitation (14% vs. 51%, p = 0.001). In conclusion, being aware of these atypical manifestations of pulmonary TB in the presence of BAF will be of great help in early detection of TB.

Tracheobronchopathia osteochondroplastica: a cause of chronic cough and haemoptysis

Tracheobronchopathia osteochondroplastica (TPO) is a rare disorder of the tracheopulmonary tree characterised by osseous and cartilaginous submucosal nodules projecting into the tracheal lumen, sparing the posterior tracheal membranous wall. Symptoms are non-specific and may include dry cough, hoarseness, dyspnoea, recurrent pneumonia and occasionally haemoptysis. A fibreoptic bronchoscopy showing multiple tracheal nodules followed by pathological biopsy is required to reach the final diagnosis. Here, we report two cases of TPO, both with history of biomass fuel exposure and almost similar clinical presentions with chronic cough, shortness of breath and intermittent haemoptysis. They both underwent fibreoptic bronchoscopy showing multiple tracheal nodules whose histopathological analysis showed the diagnosis of TPO. Both patients were treated conservatively and remained in good health afterwards. Physicians should be aware about the need of advanced surgical procedures including endotracheal stent placement in more severe cases.

Peribronchial Connective Tissue Infection Caused by Bifidobacterium longum and Veillonella Species Mimicking Lung Cancer

An 86-year-old woman was admitted for the investigation of atelectasis of the upper lobe of her right lung with a mass shadow in the hilum (Golden S sign). Chest computed tomography revealed swollen connective tissue around the right bronchus, and needle aspirate grew Bifidobacterium longum and Veillonella species. She was diagnosed with peribronchial connective tissue infection, and her condition improved with antibiotics. Although this sign is strongly suggestive of malignant disease, benign disease should be considered in the differential diagnosis. Pulmonary infection caused by Bifidobacterium longum is extremely rare; however, clinicians should consider it as a possible cause of pulmonary infections.

CT Findings of Central Airway Lesions Causing Airway Stenosis-Visualization and Quantification: A Pictorial Essay

The tracheobronchial tree is a system of airways that allows the passage of air to aerate the lungs and entire body. Several pathological conditions can affect this anatomical region. Multidetector CT (MDCT) helps identify and characterize various large airway diseases. Post-processing tools, such as virtual bronchoscopy and automatic lung analysis, can help enhance the performance of imaging studies. In this pictorial essay review, we provide imaging findings of various bronchial lesions manifested as wall thickening and endoluminal nodules on conventional MDCT and advanced image visualization and analysis.

A case of concomitant bronchial AnthracoFibrosis and tuberculosis presented as asthma-COPD- overlaps syndrome (ACOS)

In this article we present a case of a 75-year-old nonsmoker woman who was misdiagnosed as asthma-chronic obstructive airway disease overlap. The patient's history, examination and investigation confirmed the diagnosis of tuberculosis (TB) and anthracofibrosis (AFB).

Our case demonstrates the difficulties that clinicians face with when patients present with chronic wheeze without any other specific symptoms at the outset.