객담 배출이 어려운 소아청소년 결핵 의심 환자에서 굴곡성 기관지 내시경검사의 유용성

Purpose: To assess the usefulness of flexible bronchoscopy in patients with suspected pulmonary tuberculosis (PTB) who have diffi-culty in sputum expectoration. Methods: The subjects of this study were patients who were suspected of PTB and visited the Division of Pediatric Pulmonology at a tertiary hospital from April 2006 to March 2016. PTB suspects were determined by clinical symptoms, radiologic findings, and im-munologic studies. We aimed to examine the value and safety of bronchoscopy in diagnosis and differential diagnosis of PTB in PTB- suspected patients. The diagnostic criteria for PTB were defined when Mycobacterium tuberculosis was cultured in the sputum speci-men or in the bronchial washing fluid. Results: A total of 19 PTB suspects were included. One patient was diagnosed with PTB by using the sputum study. However, the re-maining 18 patients could not expectorate sputum or showed no evidence of Mycobacterium tuberculosis infection from the spu-tum study. Of the 18 patients, 15 underwent bronchoscopy. After bronchoscopy, 6 patients were diagnosed with PTB and 9 patients were diagnosed with Mycoplasma, viral, or fungal pneumonia, and tumors. For antituberculous drug resistance, there were 1 case of isoniazid (INH) resistance and 1 case of concurrent resistance to INH and prothionamide. There was no multidrug-resistant tubercu-losis. None of the patients had significant complications due to bronchoscopy. Conclusion: Flexible bronchoscopy appears to be a definitive and safe procedure for the differential diagnosis of patients suspect-ing PTB in children who have difficulty expectorating sputum. (Allergy Asthma Respir Dis 2017;5:287-293)