Endobronchial Tuberculosis Simulati...

Endobronchial Tuberculosis Simulating Foreign dead body Aspiration

Endobronchial tuberculosis is a complication of primary lung tuberculosis and may come from rupture of an infected lymph node by the agency of the bronchial wall or from lymphatic spread to the mucosal surface of the bronchial tree The clinical manifestation of endobronchial tuberculosis includes cough bronchorrhea, [1] bronchial stenosis, [2] and atelectasis. Endobronchial obstruction may also eventuate in acute respitory distress.

CASE REPORT

A six-year-old girl was admitted with quick onset of severe respiratory distress. The child was dyspneic and orthopneic with tachycardia, tachypnea, and restlessnes There was a weak cough The respiratory uninjured were hardly heard on the left lung The chest roentgenogram revealed that the left lung was chiefly opaque, and aeration could be seen simply in the superior part of the left upper lobe. Marked shift of the mediastinum to the left was interpreted as a outcome of atelectasis, possibly caused through the obstructing foreign body. The right lung was normal clinically and roentgenologically. The child was immediately taken to the operating sweep for bronchoscopic examination. A drenched material obstructuring the left main bronchus was remov at fiberoptic rigid bronchoscope. A large bleeding sore was observed several centimeters proximal to the endobronchial mass. The bleeding lesion was speculation to be the origin of the wet mass because a small part of the mass was still there. No fistula was observ and the lesion was not biopsied.

Histopathologic analysis of the material revealed a caseous granuloma, and Ziehl-Neelsen stain was positive for acid-fast tacilli. Mycobacterium tuberculosis was identified later forward culture. Triple antituberculosis therapy (streptomycin, rifampicin, and isoniazid) was started after the diagnosis of endobronchial tuberculosis was established.

Twelve hours after the removal of the foreign dead body widespread crepitations were heard forward the left lung with any degree of roentgenologic improvement. sum of two units months after the institution of antituberculosis therapy, almost entire healing was observed with the exception of a scarcely any residual infiltrates near the diaphram (Fig 1)

DISCUSSION

In this case of endobronchial tuberculosis simulating foreign corpse aspiration, the history did not remind of tuberculosis. Rare coughing in the past was attributed to common common colds by the family. There was no history of tuberculosis in any relatives or cease contacts.

The bleeding lesion that was seen upon bronchoscopic examination is considered the ruptur lymph node. We think that the granulomatous material from the ruptur node mov distally and cloged the left main bronchus.

Clinicians ne to be aware of this manifestation because this case could easily be confused clinically with foreign corpse aspiration. A recent review of 20 adult patients with endobronchial tuberculosis [3] raise that all of their patients exhibited cough 25 percent exhibited hemoptysis, and 35 percent exhibited dyspnea. However, none of these patients exhibited acute first brunt of dyspnea. In the to come endobronchial tuberculosis may be assaulted more often in patients with the acquired immunodeficiency syndrome (AIDS). Patients with AIDS many times exhibit unusual manifestations of tuberculosis, including mediastinal lymphadenits [4] and flat endobronchial tuberculosis. [5]

With this experience, we can glance at that obstructive endobronchial tuberculosis must always be kept in mind in the differential diagnosis of foreign corpse aspiration.

REFERENCES

[1] in this way SY, Lam WK, Sham MK Bronchorrhea: a presenting feature of active endobronchial tuberculosis. Chest 1983; 84:635-36

[2] Albert RK Endobronchial tuberculosis progressing to bronchial stenosis. Chest 1976; 70:537-39

[3] Ip M in such a manner SY, Lam WK, Mok CK Endobronchial tuberculosis revisited. Chest 1986; 89:727-30

[4] Duncanson FP Hewlett D Maayan s Estepan H, Perla EN, McLean T et al. Mycobacterium tuberculosis infection in the acquired immunodeficiency syndrome: a review of 14 patients. Tubercle 1986; 67:295-302

[5] Maguire GP DeLorenzo LJ Brown RB Davidian MM Case report: endobronchial tuberculosis simulating bronchogenic carcinoma in a patient with the acquired immunodeficiency syndrome Am J M Sci 1987; 294:42-44

COPYRIGHT 1989 American association of Chest Physicians

COPYRIGHT 2004 Gale Group