SESSION TITLE: Bronchology Cases
SESSION TYPE: Case Reports
PRESENTED ON: Sunday, March 23, 2014 at 09:00 AM - 10:00 AM
PURPOSE: Bronchial Anthracofibrosis (BAF) is deposition of anthracotic pigment in the bronchial wall resulting in fibrosis and stenosis of a bronchus. BAF is commonly associated with tuberculosis and smoke inhalation. We report two cases of BAF.
METHODS: Case1. A 63 year old male former smoker with past medical history of pulmonary TB treated in 2007 who presented with fever, chills and productive cough with white phlegm for one week. CT thorax showed miliary nodules, right upper lobe and left lower lobe cavitations, and tree in bud opacities in the right lower lobe. Empiric treatment for TB was started. Case 2. A 78 year old female non-smoker was admitted with a diagnosis of left lower lobe pneumonia that failed outpatient treatment. CT thorax showed collapse of a segmental bronchus in the left lower lobe with post obstructive consolidation and atelectasis.
RESULTS: Bronchoscopy showed wide spread dark pigmented, irregular bordered lesions throughout airways with stenosis of the right upper lobe bronchus in patient 1 and the lingula and left lower lobe bronchi with stenosis in patient 2. Endobronchial biopsies of the lesions showed collagenous fibrotic material, anthracotic pigment laden macrophages, and no evidence of malignancy or pathogens including AFB, consistent with diagnosis of BAF. Patient 1 remained clinically and radiologically stable after 4 weeks of follow up. Patient 2 was exposed to indoor wood burning stoves for many years during her childhood in Mexico.
CONCLUSIONS: Only one case been reported in the USA, to our knowledge, suggesting BAF is overlooked in North America. The pathogenesis of BAF is unclear and endobronchial biopsy is required to confirm the diagnosis of BAF and to rule out malignancy and infection, especially TB. No guidelines exist for management or follow up.
CLINICAL IMPLICATIONS: In patients with history of tuberculosis or smoke exposure diagnosis of anthracofibrosis should be kept in mind as cause of abnormal chest imagining and bronchial stenosis.
DISCLOSURE: The following authors have nothing to disclose: Amitesh Agarwal, Jose Valle, Gulshan Sharma, Shawn Nishi
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