The fiberoptic bronchoscopy has been used widely in diagnosing pulmonary diseases. It is a useful procedure for evaluating suspected cases of pulmonary tuberculosis. The aim of the study was to classify bronchoscopic findings of pulmonary tuberculosis and to evaluate the diagnostic yield by bronchoscopic procedure.
We have analyzed the clinical characteristics of 93 patients who had visited our hospital and been performed bronchoscopic procedure for the diagnosis of pulmonary tuberculosis from March 1, 2003 to December 31, 2003, retrospectively. Pulmonary tuberculosis was confirmed by direct smear, culture, tissue biopsy and TB-PCR in all studied subjects. Bronchoscopic findings of pulmonary tuberculosis was classified into three types (endobronchial tuberculosis, bronchial anthracosis and normal bronchus) and endobronchial tuberculosis classified into seven subtypes as stenotic type with fibrosis, stenotic type without fibrosis, actively caseating type, tumorous type, ulcerative type, and granular type.
Only 24.7% (30/93 patients) had the positive results of sputum smear and culture for AFB. For the bronchoscopic procedures, pulmonary tuberculosis was confirmed by direct smear and culture in 59.1% (55/93), bronchoscopic biopsy in 66.7% (26/39), TB-PCR in 86.3% (63/73). The patient with normal bronchial finding was 31.2% (29/93 patients) of the studied subjects. We observed that the prevalence of bronchial anthracosis was 18.3% (17/93) and endobronchial tuberculosis was 50.5% (47/93). Out of the patients with endobronchial tuberculosis, actively caseating type and stenotic type without fibrosis were observed in 34.0% (14/47), 25.5% (12/47), respectively. And we observed that the nonspecific bronchitic type, stenotic with fibrosis, tumorous type, ulcerative type and granular type were 19.1% (9/47), 6.4% (3/47), 6.4% (3/47), 6.4% (3/47) and 2.1% (1/47), respectively.
The endobronchial tuberculosis was the most frequent finding of pulmonary tuberculosis except normal bronchial finding. It is important to find out the cases with endobronchial tuberculosis early because it frequently combined with severe complications such as bronchial stenosis.
We suggest that the bronchoscopy should be considered when we evaluate the possibility of pulmonary tuberculosis in the countries with high prevalence of it.
Sang-Ha Kim, None.