Generic placeholder image

Current Respiratory Medicine Reviews

Editor-in-Chief

ISSN (Print): 1573-398X
ISSN (Online): 1875-6387

Case Report

A Case Report of an Endobronchial Tuberculosis-Challenges in Diagnosis and the Role of High-resolution CT Scans and Bronchoscopic Biopsy

Author(s): Doan Le Minh Hanh*

Volume 20, Issue 4, 2024

Published on: 08 April, 2024

Page: [367 - 371] Pages: 5

DOI: 10.2174/011573398X286626240402052433

Price: $65

Abstract

Introduction: Endobronchial tuberculosis is a challenging disease to diagnose, characterized by infection of the tracheobronchial tree caused by Mycobacterium Tuberculosis. The clinical presentation of endobronchial tuberculosis is nonspecific and variable, making it difficult to identify.

Case Report: This report explores the challenges faced during the diagnosis of endobronchial tuberculosis by a 63-year-old female patient presented with a chronic cough lasting over two months. Her chest X-ray revealed an inhomogeneous opacity in the left middle zone, accompanied by an air-bronchogram. Conventional sputum samples and other tests returned negative results. A high-resolution chest CT scan was almost complete consolidation in the lingular subsegment. A comprehensive re-evaluation was recommended in this case due to slow re-solving or non-resolving pneumonia. The histopathological examination of the biopsy sample revealed granulomatous inflammation with necrosis and lymphocytic infiltration, strongly indicating bronchial tuberculosis. The Hain test and MGIT culture confirmed the presence of Mycobacterium tuberculosis.

Conclusion: Diagnosing endobronchial tuberculosis can be challenging due to its nonspecific and variable clinical presentation. High-resolution CT scans provide valuable insights, but the absence of typical findings can complicate the diagnosis. Bronchoscopic biopsy proved to be the most reliable method for diagnosing endobronchial tuberculosis in this case. Early and accurate diagnosis is crucial for initiating appropriate treatment and preventing complications.

Keywords: Endobronchial tumor, tuberculosis, bronchoscopy, slowly resolving pneumonia, non-resolving pneumonia, consolidation, diabetes.

[1]
Shahzad T, Irfan M. Endobronchial tuberculosis: A review. J Thorac Dis 2016; 8(12): 3797-802.
[http://dx.doi.org/10.21037/jtd.2016.12.73] [PMID: 28149579]
[2]
Burrill J, Williams CJ, Bain G, Conder G, Hine AL, Misra RR. Tuberculosis: A radiologic review. Radiographics 2007; 27(5): 1255-73.
[http://dx.doi.org/10.1148/rg.275065176] [PMID: 17848689]
[3]
Iyer A, Patel SM, Jayalakshmi TK, Nair G. Endobronchial tuberculosis mimicking malignancy. Lung India 2015; 32(5): 508-10.
[http://dx.doi.org/10.4103/0970-2113.164169] [PMID: 26628772]
[4]
Roy M, Ellis S. Radiological diagnosis and follow-up of pulmonary tuberculosis. Postgrad Med J 2010; 86(1021): 663-74.
[http://dx.doi.org/10.1136/pgmj.2009.084418] [PMID: 20870648]
[5]
Marchiori E, Zanetti G, Irion KL, et al. Reversed halo sign in active pulmonary tuberculosis: Criteria for differentiation from cryptogenic organizing pneumonia. AJR Am J Roentgenol 2011; 197(6): 1324-7.
[http://dx.doi.org/10.2214/AJR.11.6543] [PMID: 22109285]
[6]
Restrepo CS, Katre R, Mumbower A. Imaging manifestations of thoracic tuberculosis. Radiol Clin North Am 2016; 54(3): 453-73.
[http://dx.doi.org/10.1016/j.rcl.2015.12.007] [PMID: 27153783]
[7]
Simon F, Chalmers JD. Brief clinical review: Non-responding pneumonia. EMJ Respir 2014; 2: 104-11.
[8]
Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44(Suppl 2): S27-72.
[http://dx.doi.org/10.1086/511159] [PMID: 17278083]
[9]
Kashyap S, Solanki A. Challenges in endobronchial tuberculosis: From diagnosis to management. Pulm Med 2014; 2014: 1-8.
[http://dx.doi.org/10.1155/2014/594806] [PMID: 25197570]
[10]
Lee KS, Yoon JH, Kim TK, Kim JS, Chung MP, Kwon OJ. Evaluation of tracheobronchial disease with helical CT with multiplanar and three-dimensional reconstruction: Correlation with bronchoscopy. Radiographics 1997; 17(3): 555-67.
[http://dx.doi.org/10.1148/radiographics.17.3.9153696] [PMID: 9153696]
[11]
Im JG, Itoh H, Shim YS, et al. Pulmonary tuberculosis: CT findings--early active disease and sequential change with antituberculous therapy. Radiology 1993; 186(3): 653-60.
[http://dx.doi.org/10.1148/radiology.186.3.8430169] [PMID: 8430169]
[12]
Hatipoğlu ON, Osma E, Manisali M, et al. High resolution computed tomographic findings in pulmonary tuberculosis. Thorax 1996; 51(4): 397-402.
[http://dx.doi.org/10.1136/thx.51.4.397] [PMID: 8733492]
[13]
Sonya S, Kwonjune JS. Tuberculosis Hunter’s tropical medicine and emerging infectious disease. (9th ed.), Elsevier 2013.
[14]
Chung HS, Lee JH. Bronchoscopic assessment of the evolution of endobronchial tuberculosis. Chest 2000; 117(2): 385-92.
[http://dx.doi.org/10.1378/chest.117.2.385] [PMID: 10669679]
[15]
Kashyap S, Mohapatra PR, Saini V. Endobronchial tuberculosis. Indian J Chest Dis Allied Sci 2003; 45(4): 247-56.
[PMID: 12962459]
[16]
Altin S, Çikrikçioğlu S, Morgül M, Koşar F, Özyurt H. 50 endobronchial tuberculosis cases based on bronchoscopic diagnosis. Respiration 1997; 64(2): 162-4.
[http://dx.doi.org/10.1159/000196662] [PMID: 9097353]
[17]
Ozkaya S, Bilgin S, Findik S, Kök HÇ, Yuksel C, Atıcı AG. Endobronchial tuberculosis: Histopathological subsets and microbiological results. Multidiscip Respir Med 2012; 7(1): 34.
[http://dx.doi.org/10.1186/2049-6958-7-34] [PMID: 23088170]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy