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Interventional Bronchoscopy in the Management of Active Bronchial Tuberculosis: A Case Report FREE TO VIEW

Jin XuRu*, MHA; Li Yuping, MHA; Chen Chengshui, MHA
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The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China

Chest. 2012;142(4_MeetingAbstracts):879A. doi:10.1378/chest.1388644
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SESSION TYPE: Bronchology Global Case Report Posters

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Airway stenosis result from bronchial tuberculosis is one of the most common cause of non-malignat airway stenosis. Balloon dilatation has become an accepted treatment to fibrotic stenosis from bronchial tuberculosis. For stenosis from active bronchial tuberculosis, interventional bronchoscopy treatment is controversial, still not standardized or unified around the world. Now we report a case of bronchial stenosis from active bronchial tuberculosis , in addition to active anti-tuberculosis treatment, we also give several interventional endoscopic treatments and success in the treatment.

CASE PRESENTATION: A 19-year-old girl presented with cough , low-grade fever for 6 months, and dyspnea for half month. She was a student with non-smoke and no past medical history . She already received systemic antituberculosis treatment for 6 months. Physical examination revealed diffuse wheezing in the lung, and she was tachypneic. Initial chest CT scan showed right mainstem bronchial stenosis, atelectasis of right middle lobe , enlargement of mediastinal lymph node(Fig 1~2). Bronchoscopy examination revealed large necrotic materials and granulation tissue in the right middle bronchus and completely obstruct the the right middle lobe (Fig 7~8). Parts of the necrotic materials were removed with biopsy forceps. Tissue also sent for pathologic examination and found necrotic granoloma in the tissue, bronchial brushings for acid-fast bacilli were positive, then active bronchial tuberculosis was confirmed. In addition to continuing antituberculosis drug therapy, she was received interventional brochoscopy treatment once a week, remove of necrotic materials, injection of antituberculosis drugs in bronchus with INH(every time 0.1g) and amikacin(every time 0.2g)and combine with crotherapy (Fig 9~10). After 2 months later, she received about 10times interventional bronchoscopic treatment ,she was improved and 6 months later, she became asymptomatic . 6 maonths later, repeat CT scan revealed shrink of mediastinal lymph nodes , right middle lung infiltration was improved (Fig 3~4). In the same time, bronchoscopy apperance showed significant improvement (Fig 11~12). 9 months later, CT scan showed little fibrotic abnormal in the right middle lobe (Fig 5~6)and bronchoscopy apperance showed right middle bronchus with scarring formation (Fig13~14).

DISCUSSION: EBTB is classified into five types, inflammatory huperaemia(I),mucosal ulcetation(II), hyperplastic polyp(III), bronchostenosis (IV)and malacia of bronchial wall(V). Type I,II,III are belong to active bronchial tuberculosis. For active bronchial tuberculosis , main therapy is effective antituberculosis treatment, but when large necrotic materials obstruct the bronchi and result in obstructive pneumonia,or ateclectasis, intervention bronchoscopy treatment play an important role in it. Although intervention bronchoscopy methodsconsist of electrocautery, , metal stent, and mechanical or balloon dialation and crotherapy,,even mitomycin C for tracheal stenosis. Whichtmethodis prefer for active bronchial tuberculosis is controversial. We think combine therapy is a good choice in the management of stenosis from active bronchial tuberculosis, first removed necrotic materials to relieve obstruction, and crotherapy arround tissue, then injection with antituberculosis drugs into the diseased bronchus. Some series reported the successful use of cryotherapy in the treatment of experimental benign tracheal strictures .It may have advantages over other treatments by modulating the healing response and resulting in improved healing and less refibrosis. But hao many times that patients need to receive or when begin to do, all these questions need to further study.

CONCLUSIONS: When active bronchial tuberculosis result in obstructive pneumonia and ateclectasis,even bronchiectasis. In addition toantituberculosis chemotherapy, interventional bronchoscope therapy may play a important role in the management.

1) Fernando HC, Sherwoo JT, Krimsky W. Endoscopic Therapies and Stents for Benign Airway Disorders: Where Are We, and Where Are We Heading? Ann Thorac Surg 2010;89:S2183-7

2) Sheski FD,Mathur PN. Long term results of fiberoptic bronchoscopic balloon dilation in the management of benign tracheobronchial stenosis. Chest,l998. l14:796-800

3) Wahidi MM,Herth FJ,Ernst A. State of the art:interventional pulmonology. Chest,2007,131:261-274

DISCLOSURE: The following authors have nothing to disclose: Jin XuRu, Li Yuping, Chen Chengshui

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The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China




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