Yonsei Med J.  2008 Aug;49(4):615-619. 10.3349/ymj.2008.49.4.615.

Endobronchial Tuberculosis Presenting as Right Middle Lobe Syndrome:Clinical Characteristics and Bronchoscopic Findings in 22 Cases

• Kim HC
• Kim HS
• Lee SJ
• Jeong YY
• Jeon KN
• Lee JD
• Hwang YS

• KMID: 1793197
• DOI: http://doi.org/10.3349/ymj.2008.49.4.615

Abstract

PURPOSE
Endobronchial tuberculosis (EBTB) presenting as right middle lobe syndrome (RMLS) is an uncommon clinical condition. We investigated the clinical characteristics in patients with EBTB presenting as RMLS. PATIENTS and METHODS: We retrospectively reviewed the records of 22 patients with EBTB presenting as RMLS who were diagnosed at our hospital from 2003 to 2006. RESULTS: Its occurrence was more common in females than males (F, 18; M, 4). The mean age was 70.3 +/- 8.5 years, and 17 patients were above the age of 65 years. Cough with sputum was the most common manifestation and 2 patients were asymptomatic. In bronchoscopic analysis, the most common finding was edematous-type EBTB, which was found in 15 patients, followed by actively caseating type in 6 and tumorous type in 1. Acid-fast bacilli (AFB) staining for bronchial washing fluid was positive in only 5 patients: 1 with edematous type and 4 with actively caseating type. Bronchoscopic biopsy showed chronic granulomatous inflammation in 16 patients. Follow-up chest X-ray after treatment showed complete disappearance of the lesion in 2 patients, more than 50% improvement in 5, less than 50% improvement in 5, and no change of lesion in 4. CONCLUSION: Edematous-type EBTB was the most common type of EBTB presenting as RMLS, and it usually occurred in elderly patients. Culturing for mycobacterium and histologic examination by bronchoscopy are necessary for proper diagnosis in these patients.

Keyword

Endobronchial tuberculosis; right middle lobe syndrome

MeSH Terms

Aged
Aged, 80 and over
Bronchial Diseases/*pathology/*radiography
Bronchoscopy
Female
Humans
Male
Middle Aged
Middle Lobe Syndrome/*pathology/*radiography
Tuberculosis/complications/*pathology/*radiography

Figure

• 

  Fig. 1 Chest X-ray of a 72-year-old man with chronic cough. It shows persistent right middle lobe collapse in serial chest X-ray after 6 months of anti-tuberculous treatment (A) before treatment, (B) after treatment. Bronchoscopic findings showed a mass-like lesion with some necrotic tissue in the middle lobe that completely occluded the bronchial lumen; initial diagnosis (C) and fibrotic scarring in serial bronchoscopy after 3 months of treatment (D).

• 

  Fig. 2 (A) Bronchoscopic findings of a 69-year-old woman with chronic cough. Bronchoscopic findings showed an inflammatory change with mucosal edema and some secretion. The middle lobe was narrowed by an edematous change of the mucosa, indicating edematous-type EBTB. (B) Bronchoscopic findings of a 52-year-old woman with chronic cough. Bronchoscopic findings showed whitish necrotic material in the middle lobe, indicating actively caseating-type EBTB. Upon biopsy specimen, numerous bacilli were observed on AFB staining. EBTB, endobronchial tuberculosis.

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