| Endobronchial tuberculosis (EBTB), is defined as tuberculous infection of the tracheobronchial tree. It is often accompanied by pulmonary tuberculosis. Now incidence rate of EBTB has been increasing.Clinical features and chest radiograph are mostly nonspecific. EBTB is often misdiagnosed. EBTB without effective treatment may lead to cicatricial stenosis or malacia in tracheobronchial, which contributes to Hmitition of ventilation. Atelectasis and collapse come to some of serious cases. Findings of the onset characteristics and clinical features of EBTB are not consistent in the literature. Therefore, we conducted a retrospective analysis of 132 EBTB cases in the Changhai Hospital.Objective: To understand the onset characteristics and clinical features of EBTB, we retrospectively investigated the 132 EBTB cases which were diagnosed between September 1999 and March 2004. The retrospective investigation provided information on how to observe the characteristics of EBTB and usual lesion through fiberoptic bronchoscope. The type of EBTB conies in order to special present under fiberoptic bronchoscope, which reveal the various results of different EBTB's type. In addition, this paper release the significant values of new classification to the diagnosis and treatment of EBTB.Methods: We conducted a retrospective analysis of 132 EBTB cases in the Changhai Hospital. ( 2 1 males, 111 females ) : 1 .analyze the clinical features of the patients and the laboratory results and findings of chest roentgenogram; 2. The type of EBTB comes in order to special present under fiberoptic bronchoscope, which reveal the various results of different EBTB's type by the bronchoscopic findings.Results:1 .Demographical Characteristics: There were 111 females and 21 males, with a mean age of 34.2 1.1 (range: 13-69yr) The male to female ratio was 1:5.3. There were 71 patients (53.8%) less than 35 years old, the most incidence rate was in 21-40 years old.2.Onset Findings, Misdiagnosis and Missed Diagnosis: Seventy eight out of 132 patients(59.1%) had pulmonary tuberculosis. The incidence of EBTB without pulmonary tuberculosis was 35.6 percent. The rate of misdiagnosis is 80.9 percent. The time interval between onset and final diagnosis was 10.2 months (range: 1 week to 7 years). The rate of total misdiagnosis was 68.9% and the rate of total missed diagnosis was 45.5%.3. Clinical Features: Main symptoms were as follows: intractable cough in 89.4% (118/132), sputum in 63.6% (84/132), chest discomfort and dysnea after exercise in 31.8% (42/132) ,fever in 29.6% (39/132) , sweat, malaise in 13.6% (18/132) , wheezing in 8.3% (11/132) , haemoptysis in 10.6% (14/132) .Physical signs: decreased breath sounds in 62cases (47.0%), localized wheezing in 31 (23.5%) .4. Laboratory results: PPD skin test: recorded in 26 cases, almost more than moderate reaction (73.17%) , the rate of positive smear for acid-fast bacilli was 38.6%; 62 cases (66.1 percent) were identified on the tissue sections.5. Findings of chest CT results: observed in 64 cases, the narrowing of main or lobar bronchus in 33(51.6%), atelectasis in segment, lobar and full lung in 19(29.7%), obstructive pneumonia in 9 (14.1%), obstructive emphysema in 8 (12.5%) .6. Bronchoscopic findings: (1)Most lesions looked cicatrical stenosis in 58(43.9%), followed by edematous-hyperemic in 15(11.4%),ulcerative-caseous necrosis in 25(18.9%), granular proliferation in 20(15.2%), tracheobronchial malacia in 14 (10.6%). (2)Lesion locus: trachea in 28 cases; left main bronchus in 81,right main bronchus in 20,left upper lobar bronchus in 29, left lower lobar bronchus in 20, right upper lobar bronchus, in 10, right-truncus intermedius in 4, right-middle lobar bronchus in 11, right-lower lobar bronchus in 9.(3)62 cases (66.1 percent) of ongoing leisions were identified on the tissue sections. (4)In the follow-up of patients with lesions of the ulcerative-caseous necrosis types, the anti-tuberculosis drug therapy proved to be more effective for the remission of the disea... |
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