| Background: Tracheobronehial tuberculosis (TBTB) is defined as a tuberculousinfection of the tracheobronchial mucosa, submucosa, smooth muscle, cartilage andouter membranes with microbial or histopathological evidence, with or withoutparenchymal involvement. The incidence of TBTB has been increasing in recent years,but because of lacking of specific clinical manifestations and normal imagingperformance in a few of patients, the missed diagnosis and misdiagnosis rate remainshigh.Objective: We aimed to improve the understanding of TBTB and reduce the misseddiagnosis and misdiagnosis by investigating the clinical features of TBTB.Methods: We collected the clinical data of152patients who were diagnosed withTBTB by Respiratory Medicine Dept. of Jilin University Second Hospital usingbronchosopy. Retrospective analysis was performed on the clinical features,bronchoscopy, performance, bacteriological examination, imaging of the patients.Result: The resulet include demographic characteristics, clinical features, chest CTperfermance, bronchoscopy perfermance and characteristics of right middle lobesyndrome.1. Demographic characteristics: the study included39male and113female in thetotal patients with TBTB, the male-to female ratio was1:2.90.The mean age was44.8±18.1years ranging from14to81years.64patients (42.1%) were younger than40-years-old,18patients (11.8%) were older than70-year-old, the age of the other70patients (46.1%) were between40to70years.2. Most common symptoms were cough (134cases,88.2%), sputum (93cases,61.2%), fever (67cases,44.1%), hemoptisis (21cases,13.8%), dyspnea (34cases,22.4%), constitutional symptoms (62cases,40.8%), respectively.70percent patientshave more than one symptom,only5cases (3.30%) were asympomatic. Physical examination indicated weakened respiratory sounds (70cases,51.5%) and permanentexhale rhonchi (35cases,25.7%).3. Chest CT scan revealed bronchial stenosis or bronchial wall thickening(62cases,51.6%), bronchial stenosis and atelectasis (46cases,38.3%),“tree in bud”sign (76cases,63.3%), hilar or mediastinal lymph node enlargment (31cases,25.8%), normal results (2cases,1.67%).4. The bronchoscopy results indicated inflammatory infiltraton type (23cases,15.1%), ulceration necrosis type (44cases,28.9%), proliferative granulation type(27cases,17.8%), scar stenosis type (37cases,24.3%), the wall softening type(8cases,5.3%), lymph fistula type(13cases,8.6%). TBTB has a predilection fortrachea (41cases,27.0%) and left main bronchus (39cases,25.7%).Biopsy andBronchotracho Alveolar Larvage Fliud acid-fast bacilli staining:126paitents werereceived a biospy by bronchoscopy, pathology results of79cases show tuberculosis,the positive rate was62.7%. The positive rate of BAL acid-fast bacilli staining was41.8%, in which ulceration necrosis type a had the highest positive rate which was76.2%respectively. The diagnosis positive rate of TBTB by bronehoseopy tissueseetion is higher than that by BAL for acid-fast bacilli.5. Characteristics of right middle lobe syndrome (RMLS): RMLSis an uncommon clinical condition.10cases show right middle lobe syndrome,the mean age was57.8±15.02years.9patients were older than46-year-old. Thebronchoscopy results indicated ulceration necrosis type and inflammatory infiltratontype are common.Conclusion: TBTB have a predilection for females, but it is becoming more and morecommon in elder people. The symptom is nonspecific, irritable cough and mucussputum are the most common symptom.The CT scan can evaluate the condition oftracheobronchial tree and parenchyma simultaneously, bu few paitents CT scan resultshave no abnormal alterations. The diagnosis of TBTB depends on the bronchoscopy. |
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