Fiberoptic Bronchoscopy And Bronchoalveolar Lavage For Diagnosis Of Childhood Atypical Pulmonary Tuberculosis

Objective:To explore the use and value of fiberoptic broncho scopy and bronchoalveolar lavage in diagnosis of atypical pulmonary tuberculosis in children.Methods:A total of527cases with suspected pulmonary tuberculosis during the period from January2008to December2010were collected,among which67patients with sputum-negative and difficult diagnoses had fiberoptic bronchoscopy and bronchoalveolar lavage.Combined with clinical and imaging findings,we analyse the features of difficult cases in fiberoptic bronchoscopy and the value of the detection rate of mycobacterium tuberculosis after fiberoptic bronchoscopy.Results: Combined with clinical and imaging findings,35cases(52.2%) were diagnosed as atypical pulmonary tuberculosis after fiberoptic bronchoscopy and bronchoalveolar lavage, and22cases(32.8%) were precluded.The clinical manifestations of difficult diagnoses pediatric pulmonary tuberculosis were atypical.Primary pulmonary tuberculosis is the most common type(54.3%),and34.3%cases combined with endobronchial tuberculosis.It mainly expresses for narrowed orifice of the lobe bronchus caused by extrinsic compression(42.9%),eoplasm(25.7%), caseoussubstance(20.0%) and secretions(17.1%) under fiberoptic bronchoscopy.The detection rate of mycobacterium tuberculosis was88.6%through bronchoalveolar lavage fluid(BALF) and sputum/gastrointestinal fluid after fiberoptic bronchoscopy.The positive rate of BALF mycobacterium tuberculosis-polymerase chain reaction(MTB-PCR) was the highest.4cases were diagnosed by transbronchial biopsy.Conclusion:Fiberoptic bronchoscopy can improve the diagnosis rate and detection rate of mycobacterium tuberculosis in pediatric atypical pulmonary tuberculosis observably,especially in endobronchial tuberculosis cases. Objective:To explore the clinical characteristics and the value of bronchoscopy examination in diagnosis and treatment of atypical endobronchial tuberculosis in children.Methods:A total of35cases with atypical pulmonary tuberculosis during the period from January2008to December2011had bronchoscopy examination, among which12patients were diagnosed with endobronchial tuberculosis. Combined with the medical history, clinical manifestation, Imaging and laboratory findings, we analyse the features.Results:The clinical symptoms of pediatric atypical endobronchial tuberculosis were various, however, the primaries were cough and fever and may include persistent wheeze and shortness of breath following exercise. Hemoptysis was rare. The primary imaging findings was hilar and(or) mediastinum lymph node enlargement. Obstructive pulmonary emphysema and atelectasis were more common than other types of pulmonary tuberculosis. Contrast-enhanced chest CT scans has a greater value than chest X-ray in diagnosis of atypical endobronchial tuberculosis. It mainly expresses for granulation tissue, neoplasm, caseoussubstance and extrinsic compression under fiberoptic bronchoscopy. The detection rate of mycobacterium tuberculosis was50.0%(6cases) through bronchoalveolar lavage fluid(BALF).Four children were diagnosed by transbronchial biopsy and2cases by gastrointestinal fluid smear after fiberoptic bronchoscopy.Conclusion:The clinical symptoms of pediatric atypical endobronchial tuberculosis were various.Bronchoscopy examination, bronchoalveolar lavage and transbronchial biopsy placed very important roles in diagnosis and pathological classification in paediatric atypical endobronchial tuberculosis.