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J Korean Med Assoc. 2006 Sep;49(9):799-805. Korean. Original Article.
Chung HS .
Department of Internal Medicine, Seoul National University College of Medicine, Korea.

Endobronchial tuberculosis is defined as a specific inflammation of the trachea or major bronchi caused by tubercle bacilli. Active disease can be diagnosed when certain endobronchial lesions-such as whitish gelatinous material, ulcer, tumor, stenosis, or inflammation-exist on bronchoscopy and tuberculosis is proven by bronchoscopic biopsy of these lesions. In pulmonary tuberculosis, resected lung specimens frequently show either ulceration or stenosis of the draining bronchioles or bronchi, and the same endobronchial processes may result in bronchiectasis due to destruction of the bronchial wall. These lesions are included in the disease entity of pulmonary tuberculosis rather than that of endobronchial tuberculosis because those endobronchial lesions distal to lobar bronchi do not have clinical significance. Fibrotic stenosis of bronchi may be inactive lesions resulting from prior endobronchial tuberculosis though sputum examination for acid-fast bacilli is positive, since the sequela of endobronchial tuberculosis and reactivated pulmonary tuberculosis can be present coincidentally. Therefore, it is necessary to obtain histologic proof of tuberculosis for a definite diagnosis of endobronchial tuberculosis. Endobronchial tuberculosis is a specific form or a significant complication of pulmonary tuberculosis, and it frequently causes matters of grave concern; (1) delay in diagnosis, (2) misdiagnosis as bronchial asthma, and (3) bronchial stenosis. The human immunodeficiency virus (HIV) epidemic and multidrug-resistant strains of tubercle bacilli may be associated with a higher incidence of endobronchial tuberculosis. Therefore, endobronchial tuberculosis continues to be a health problem, though the incidence of tuberculosis affecting respiratory organs including the trachea and bronchi has been greatly reduced. Endobronchial tuberculosis should be borne in mind when patients are young female adults or adolescents who present with symptoms suggestive of asthma and/or with unusual roentgenographic patterns, or in patients with HIV infection.

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