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1、Bronchoscopic Assessment of the Evolution of Endobronchial Tuberculosis*Hee Soon Chung, MD, FCCP; and Jae Ho Lee, MDBackground: We previously classified forms of endobronchial tuberculosis (EBTB) into seven subtypes by bronchoscopic finding: actively caseating, edematous-hyperemic, fibrostenotic, tu
2、morous, granular, ulcerative, and nonspecific bronchitic. Study objective: To evaluate the value of this classification in predicting the therapeutic outcome of EBTB. Design: A prospective study with serial bronchoscopy performed from the diagnosis of EBTB to the completion of antituberculosis chemo
3、therapy. Participants: Eighty-one patients with biopsy-proven EBTB. Interventions: Fiberoptic bronchoscopy was done every month until there was no subsequent change in the endobronchial lesions, every 3 months thereafter, and at the end of treatment. Results: Twenty-two of the 34 cases of actively c
4、aseating EBTB changed into the fibrostenotic type, and the other 12 healed without sequelae. Seven of the 11 cases of edematous-hyperemic EBTB changed into the fibrostenotic type, and the other 4 healed. Nine of the 11 cases of granular EBTB, 6 cases of nonspecific bronchitic EBTB, and 2 cases of ul
5、cerative EBTB resolved completely. However, the other two cases of granular EBTB changed into the fibrostenotic type. Seven cases of fibrostenotic EBTB did not improve despite antituberculosis chemotherapy. These various changes in bronchoscopic findings occurred within 3 months of treatment. In 10
6、cases of tumorous EBTB, 7 progressed to the fibrostenotic type. In addition, new lesions appeared in two cases, and the size of the initial lesions increased in another two cases, even at 6 months after treatment. Conclusions: The therapeutic outcome of each subtype of EBTB can be predicted by follo
7、w-up bronchoscopy during the initial 3 months of treatment, with the exception of the tumorous type. In tumorous EBTB, close and long-term follow-up is advisable because the evolution of the lesions during treatment is very complicated and bronchial stenosis may develop at a later time. (CHEST 2000;
8、 117:385392)Key words: bronchoscopic finding; bronchoscopy; endobronchial tuberculosis; evolution; subtypeAbbreviation: EBTB 5 endobronchial tuberculosisThe incidence of tuberculosis affecting respiratory organs including the trachea and bronchi has been greatly reduced, especially in the past 50 ye
9、ars.1 Nevertheless, endobronchial tuberculosis (EBTB) continues to be a health problem1because of the following: (1) its diagnosis is frequently delayed because the decreased incidence itself diminishes the suspicion of tuberculosis2; (2) bronchostenosismay develop as a serious complication despite
10、effi- cacious antituberculosis chemotherapy35; and (3) it is often misdiagnosed as bronchial asthma68or lung cancer.911Moreover, there has recently been an unprecedented resurgence of tuberculosis that is related to the HIV epidemic, multidrug-resistant strains, poverty and homelessness, immigration
11、, and failures in the treatment system,1214and the HIV epidemic may be associated with a higher incidence of EBTB.11,15 The pathogenesis of EBTB is not yet fully estab- lished. However, sources of EBTB may include direct implantation of tubercle bacilli into the bron- chus from an adjacent pulmonary
12、 parenchymal le- sion, direct airway infiltration from an adjacent tuberculous mediastinal lymph node, erosion and*From the Division of Pulmonology, Department of Internal Medicine, Seoul Municipal Boramae Hospital Affiliated to Seoul National University Hospital, Seoul, Korea. Supported in part by
13、the Seoul Municipal Boramae Hospital. Manuscript received February 22, 1999; revision accepted Sep- tember 9, 1999. Correspondence to: Hee Soon Chung, MD, FCCP, Department of Internal Medicine, Seoul Municipal Boramae Hospital, #395 Shindaebang-2-Dong, Dongjak-Gu, Seoul, 156707, Korea; e- mail: hsch
14、ungbrm.co.krCHEST / 117 / 2 / FEBRUARY, 2000385protrusion of an intrathoracic tuberculous lymph node into the bronchus, hematogenous spread, and extension to the peribronchial region by lymphatic drainage.9,10,1618 The clinical course of EBTB is variable because not only are there several possible p
15、athogenetic mechanisms, but the interaction between the effect of mycobacteria, host immunity, and antituberculous drugs is complex, and any variation in these three factors may result in an altered course.19Therefore, the forms of EBTB need to be classified into sub- types. We previously classified
16、 forms of EBTB into seven subtypes by bronchoscopic finding: actively caseat- ing, edematous-hyperemic, fibrostenotic, tumorous, granular, ulcerative, and nonspecific bronchitic.2 However, it was not known whether the proposed classification had predictive value after treatment. Here, we show the value of this classification in predicting the outcome of EBTB after the treatment in a prospective clinical study.Materials and MethodsThe diagnostic criteria of active EBTB were as follows: (1
