Bronchoscopic Findings in Patients With Pulmonary Tuberculosis

Abstract

Objectives To qualify and to quantify endobronchial involvement in patients with bacillary pulmonary tuberculosis at diagnosis and after treatment. Design Prospective study with series of patients. Patients Seventy-five adults with acid-fast bacilli in the sputum, including one with pleural effusion and collapse of the left lower lobe and one with milliary tuberculosis. Most patients had extensive cavitary lesions. Bronchoscopy was performed at diagnosis on all patients. At the conclusion of the treatment bronchoscopy was repeated on 49 patients. Endoscopic abnormalities were classified according to Chung et al. Results The first bronchoscopy was normal in 7 patients and abnormal in 70. Abnormalities were classified into nonspecific bronchitis—37 (48%), edematous-hyperemic—22 (28.6%), fibrostenotic—7 (9%), granular—1 (1%), ulcerative—2 (2.5%), and tumorous—1 (1.0%). Involvement of lobar and segmental bronchi was seen in 45 patients (single involvement in most cases). Involvement of the trachea, main bronchi, and bronchial tree was seen in 25 patients. Involvement of lower lobes, right middle lobe, and lingual bronchi was uncommon. Biopsies were performed on 64 patients and only one normal result was obtained. Granulomas were observed in 12 patients. Nonspecific chronic inflammatory reactions were seen in 52 patients. Bronchoscopies were performed on 49 patients after treatment with the following findings: 4 were normal; fibrostenosis was observed in 28 patients and fibrosis in 17. Of the 34 patients with initial nonspecific bronchitis or edematous-hyperemic types, 20 progressed to fibrosis and 11 to fibrostenosis, which was severe in almost all patients. Conclusions Endobronchial tuberculosis is very common in patients with acid-fast bacilli in the sputum. Cure without sequelae is extremely rare.