대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Endobronchial tuberculosis and tuberculous pleurisy

Radiologic Findings

Plain radiographs show left pleural effusion and partial collapse of upper division of left upper lobe. CT scans reveal soft tissue attenuation in left upper lobe upper divisional bronchus and peripheral consolidation in anterior segment of left upper lobe. Left pleural effusion with small amount of air, which caused by pleural biopsy, is also

seen. Endobronchial tuberculisis with tuberculous pleurisy were confirmed by pleural Bx & bronchial washing cytology.

Brief Review

Endobronchial TB (EBTB) is defined as infection of the tracheobronchial tree as documented by microbiologic and histopathologic proof. The pathogenesis of EBTB is not yet fully established. However, it usually occurs in association with pulmonary involvement and is believed to result most commonly from the implantation of organisms from infected sputum in persons with cavitary (progressive primary and postprimary) disease. In the absence of parenchymal cavitation, possible sources include direct extension from adjacent parenchymal infection, lymph node erosion, hematogenous spread, and extension to the peribronchial region via lymphatic drainage. Airway lesions typically evolve from submucosal sites of infection associated with ulceration to hyperplastic inflammatory polyps that eventually heal by fibrosis and result in circumferential stenosis. EBTB can be classifed into seven subtypes by bronchoscopic finding: actively caseating, edematous-hyperemic, fibrostenotic, tumorous, granular, ulcerative, and nonspecific bronchitic. EBTB in adults with primary disease may manifest radiologically as atelectasis and endoluminal or peribronchial masses simulating neoplastic disease. Consolidation confined to the lower lung zones and normal findings are other atypical radiographic patterns well documented to be associated with endobronchial tuberculosis.

References

1. Ann N. Leung. Pulmonary Tuberculosis: The Essentials. Radiology 1999; 210: 307-322.

2. Soon Chung HS, Lee JH. Bronchoscopic Assessment of the Evolution of Endobronchial Tuberculosis. Chest.

2000;117:385-392

Keywords

Airway, Pleura, Infection, bacterial infection, Tuberculosis,