Tracheobronchial tuberculosis observed from the chest X-ray findings and its pathogenesis

Twelve cases of tuberculous tracheobronchitis were identified by bronchofiberscopy out of 185 tuberculous patients, and they are classified into four groups based on the chest X-ray findings and its pathogenesis, Group 1 (two cases); extensive endobronchial tuberculosis without radiographically demonstrable lesion. Group 2 (three cases); endobronchial tuberculosis occurring in airway that drains a pulmonary cavity or active lesion. Group 3 (four cases); endobronchial tuberculosis occurring in minimal cases of tuberculosis with radiographically fibrocaseous or fibroproductive type lesions. Group 4 (three cases); invasion of bronchus by perforation of hilar tuberculous adenitis. This classification would undoubtedly be better to understand tuberculous involvement of the bronchial tree than those previously reported classifications based on the bronchoscopic findings and clinical symptoms. Furthermore, it was found that the extent of the lung lesions showed no relation with the incidence of tuberculous tracheobronchitis. There is some differences among these four groups in terms of chest roentgenographic features, clinical symptoms and bronchoscopic findings. However, the presence of the third group has not been clearly recognized, as such type of the disease believed to exist in cases with extensive pulmonary involvement. Characteristics of the third group are mild clinical symptoms, inactive radiographic appearances and insidious clinical course, and most such cases are detected by the mass survey, and the diagnosis can be made only by endoscopic examinations. The incidence of tracheobronchial tuberculosis in our clinic was 6.5%, and that of the fourth group was 1.6%. Brief discussion was made on the endoscopic classification, pathogeneses, endoscopic changes during the course of chemotherapy and management of bronchial stenosis.