대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 285 Date 2003-04-12

  • Courtesy of Yeon Joo Jeong, M.D., Tae Sung Kim, M.D., Kyung Soo Lee, M.D. / Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
  • Age/Sex 69 / M
  • Chief ComplaintNonproductive cough
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Bronchial Anthracofibrosis (Inflammatory Bronchial Stenosis with Anthracotic Pigmentation)
Radiologic Findings
Chest radiograph shows segmental air-space consolidation and atelectasis in the right upper lobe.Contrast-enhanced CT scans show luminal narrowing and bronchial wall thickening of right upper and left lower lobar bronchus with peribronchial calcified lymph nodes.

Fiberoptic bronchoscopy shows irregularity and dark pigmentation in the bronchial mucosa associated with mild narrowing of bronchial lumen. (A-view from left upper lobar bronchus; B-view from narrowed right upper lobar bronchus).
Brief Review
Anthracofibrosis is a bronchoscopic finding showing dark anthracotic pigmentation on the bronchial mucosa in conjunction with bronchial narrowing or obliteration (1). Characteristic features of the patients with anthracofibrosis in one study were as follows (1): (a) preponderance of older female patients; (b) no association with pneumoconiosis or smoking; (c) chief complaints of cough and dyspnea without constitutional symptoms; (d) segmental or lobar consolidation on simple chest radiographs; (e) abnormalities of bronchial airways with peribronchial cuffs of soft tissue or surrounding lymph nodes on chest CT; (f) most frequent involvement of the right middle lobe bronchus, and (g) active tuberculous infection demonstrated in >60% of the patients. Recent investigators propose that bronchial tuberculosis is one of the most likely causes for the development of bronchial anthracofibrosis. The hypothesis about the development of bronchial anthracofibrosis is as follows. Perforation of a tuberculous lymph node into the adjacent bronchi and carbon particles in the lymph nodes may penetrate through the bronchial wall as deep as the mucosa, resulting in coloring of the bronchial mucosa. Subsequently, healing with fibrotic response may occur in the bronchi, resulting in bronchial narrowing or obstruction with anthracitic pigmentation (1).
References
1. Chung MP, Lee KS, Han J, Kim H, Rhee CH, Han YC, Kwon OJ. Bronchial stenosis due to anthracofibrosis. Chest. 1998; 113:344-350.
Keywords
Airway, Non-infectious inflammation, Bronchial Anthracofibrosis (Inflammatory Bronchial Stenosis with Anthracotic Pigmentation)

No. of Applicants : 29

▶ Correct Answer : 13/29,  44.8%
  • - Asan Medical Center, Korea Eun Jin Chae
  • - Chungju Hospital Konkuk University, Korea Chang Hee Lee
  • - Ewha Womans' University Hospital, Korea Sung Shine Shim
  • - Gwangmoung Seongae Hospital, Korea Jiyong Rhee
  • - Hangang Sacred Heart Hospital, Korea Eil Seong Lee
  • - Incheon Sarang Hospital, Korea Jung Hee Kim
  • - Ospedale di Jesi, Italy Giancarlo Passarini
  • - Seoul National Hospital, Korea Euna Park
  • - Seoul National University Hospital, Korea Jung-Gi Im
  • - Seoul National University Hospital, Korea Sang Young Kim
  • - Social Security Hospital, Ankara, Turkey Meric Tuzun
  • - Sunlin Hospital. Pohang, Korea Won Hyuk Shin
  • - Ulsan University Hospital, Korea Kwang-Won Seo
▶ Semi-Correct Answer : 16/29,  55.2%
  • - Annecy Hospital, France Gilles Genin
  • - China Medical College Hospital, Taichung, Taiwan Tsai Po-pang
  • - CHU Grenoble, France Mathieu Rodiere
  • - CHU Nancy-Brabois, France Denis Regent
  • - Chung Li Ten-Chen Hospital,Taiwan Gui-Lin Zheng
  • - Dept of IM, Seoul National University Hospital, Korea Sang-Min Lee
  • - Dept of IM, Seoul National University Hospital, Korea Changmin Choi
  • - Kangbuk Samsung Hospital, Korea Semin Chong
  • - Kovai Medical Center, India Jyothi Priya
  • - MH(CTC), Pune, India Vivek Sharma
  • - National Medical Center, Korea Sang Kyu Yang
  • - National Taiwan University Hospital, Taiwan Kao-Lang Liu
  • - Ohio State University, Ohio, USA Sumit Seth
  • - Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
  • - Prever-Centro Radiologico, Brazil Arismar Leon Pereira
  • - Xray clinic pune, India Anand Rahalkar
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