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Weekly Chest CasesArchive of Old Cases

Case No : 376 Date 2005-01-08

  • Courtesy of Min-Ju Kim, M.D., Jae-Woo Song, M.D. / Asan Medical Cneter, University of Ulsan, Seoul, Korea
  • Age/Sex 53 / M
  • Chief ComplaintCough for two months
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Tracheobronchial tuberculosis
Radiologic Findings
Chest PA shows irregular narrowing of the tracheal air-column. Contrast-enhanced CT scans reveal diffuse wall thickening with irregular luminal narrowing, and wall enhancement of trachea and both main bronchi. Multiple low-attenuation foci within the thickened tracheobronchial wall are also noted. Tracheobronchial tuberculosis was confirmed by bronchial washing culture.
Brief Review
Tracheobronchial tuberculosis can be secondarily involved by repeated implantation of the organism from cavitary pulmonary lesions containing abundant Mycobacterium tuberculosis. In the development of central airway tuberculosis, however, spread along peribronchial lymphatic channels appears to play a more important role than direct airway spread by infected sputum. Another mechanism is local extension from adjacent mediastinal tuberculous lymphadenitis. When tuberculosis directly involves the bronchial wall, the disease undergoes several evolutional stages, which include early formation of tubercles in the submucosal layer, ulceration and necrosis of the mucosal wall, and healing with variable degree of fibrosis and residual stenosis. On CT scans, airway narrowing, airway obstruction with atelectasis, irregular thickening of bronchial wall with luminal narrowing, and contrast enhancement of the thickened bronchial wall are seen.

Diffuse diseases of the central airway include Wegener granulomatotosis, relapsing polychondritis, tracheobronchopathia osteochondroplastica, and amyloidosis. Differentiation from relapsing polychondritis and tracheobronchopathia osteochondroplastica can be made by involvement of the posterior membranous portion.
References
1. Prince JS, Duhamel DR, Levin DL, et al. Nonneoplastic lesions of the tracheobronchial wall. Radioogy 2002;22:S215-S230.

2. Moon WK, Im JG, Yeon KM, et al. Tuberculosis of the central airways. AJR 1997;169:649-653.
Keywords
Airway, Infection, Bacterial infection, Tuberculosis,

No. of Applicants : 51

▶ Correct Answer : 17/51,  33.3%
  • - Asan Medical Center, Korea Eun Jin Chae
  • - Boomin Hospital, Korea Sangwoo Lee
  • - Busan Veterans Hospital, Korea Suhku Huh
  • - Centre d'imagerie Jacques Callot, Nancy, France Lionel Cannard
  • - CIM Saint Dizier, France JC Leclerc
  • - Dong-A University Hospital, Korea Ki-Nam Lee
  • - Ev. Krkhs. Hubertus, Berlin, Germany Michael Weber
  • - Ewha Womans University Mokdong Hospital, Korea Yoo Kyoung Kim
  • - Gwangmyoung Sung-Ae Hospital, Korea Jiyong Rhee
  • - Hangang SacredHeart Hospital, Korea Eil Seong Lee
  • - Hanyang University Hospital, Seoul, Korea Yo Won Choi
  • - Incheon Sarang Hospital, Korea Jung Hee Kim
  • - Jeil hospital, Jinju, Korea Hyunggon Lee
  • - Korea University Hospital, Korea Kyoung-Rae Kim
  • - Samsung Medical Cneter, Korea Ha Young Kim
  • - Seoul National University Hospital, Korea Heesun Park
  • - Social Security Hospital, Ankara, Turkey Meric Tuzun
▶ Semi-Correct Answer : 13/51,  25.5%
  • - Al-Mana General Hospital, Saudi Arabia Tamer I.F.M. Marei
  • - Annecy Hospital, France Gilles Genin
  • - Annemasse Polyclinique De Savoie, France Gay-Depassier Philippe
  • - Apollo Firstmed Hospitals, Chennai,India RG Gopinath
  • - ASL BOLOGNA Maggiore Hospital, Bologna, Italy Marcellino Burzi
  • - CHU Nancy-Brabois, France Denis Regent
  • - Hereford County Hospital, UK Joy A Thomas
  • - Homs National Hospital, Homs, Syria Rami Abou Zalaf
  • - Hospital Cotia Saude - Brazil JLM de Almeida Prado
  • - Hospital Monaldi, Naples, Italy. Gaetano Rea
  • - Max Hospital, Delhi, India Vickrant Malhotra
  • - Monaldi Hospital, Naples, Italy. Gaetano Rea
  • - Sharma Clinic, Jaipur, India Dinesh Sharma
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Current Editor : Sung Shine Shim, MD, PhD. Email : sinisim@ewha.ac.kr

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