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The Value of Roentgenographic and Fiberbronchoscopic Findings in Predicting Outcome of Adults With Lower Lung Field Tuberculosis

The Value of Roentgenographic and Fiberbronchoscopic Findings in Predicting Outcome of Adults... Abstract Proper antituberculosis chemotherapy may not prevent occurrence or progression of endobronchial involvement in patients with pulmonary tuberculosis. We previously reported a higher incidence of endobronchial involvement in adults with lower lung field tuberculosis (LLFTB). We evaluated the value of roentgenographic and fiberbronchoscopic findings in predicting the outcome of adults with LLFTB after 9 months of antituberculosis chemotherapy. The most common change on chest roentgenograms among 101 patients with LLFTB was consolidation, followed by cavitary lesion, lung collapse, and solitary mass. Intrathoracic lymphadenopathy (hilar and/or mediastinal lymphadenopathy) was found in 12 cases. Sputum smear for acidfast bacilli was positive in 64 patients, and sputum culture for tuberculous bacilli was positive in 37 of 50 patients. Endobronchial involvement was found in 45 of 63 patients who underwent fiberbronchoscopic examination. Of these 45,18 had ulcerative granuloma, 12 had fibrostenosis, eight had submucosal infiltration, and seven had mucosal redness and swelling. A higher incidence of endobronchial involvement was found in the patients with LLFTB when they presented with roentgenographic findings of pulmonary consolidation, lung collapse, or associated intrathoracic lymphadenopathy. The outcome seemed unfavorable in the patients with LLFTB who presented with roentgenographic findings of lung collapse or pulmonary consolidation, or in those who presented with fiberbronchoscopic findings of fibrostenosis or ulcerative granuloma. Our results show that roentgenographic and fiberbronchoscopic findings are of value in predicting outcome of patients with LLFTB. With proper antituberculosis chemotherapy and close follow-up, fiberbronchoscopy may be clinically indicated in patients with LLFTB to assess the presence and severity of endobronchial involvement. Early surgical intervention can be considered in those with severe endobronchial involvement before serious sequelae occur. (Arch Intern Med. 1991;151:1581-1583) References 1. Segarra F, Sherman DS, Rodriguez-Aguero J. Lower lung field tuberculosis . Am Rev Respir Dis . 1963;87:37-40. 2. Parmar MS. Lower lung field tuberculosis . Am Rev Respir Dis . 1967;96:310-313. 3. Berger HW, Granada MG. Lower lung field tuberculosis . Chest . 1974;65:522-526.Crossref 4. Hamilton CE, Fredd H. Lower lung field tuberculosis: a review . JAMA . 1935;105:427-430.Crossref 5. Chang SC, Lee PY, Perng RP. Lower lung field tuberculosis . Chest . 1987;91:230-232.Crossref 6. Auerbach O. Tuberculosis of the trachea and major bronchi . Am Rev Tuberc . 1949;60:604-620. 7. Salkin D, Cadden AV, Edson RC. The natural history of tuberculous tracheobronchitis . Am Rev Tuberc . 1943;47:351-359. 8. Smart J. Endobronchial tuberculosis . Br J Dis Chest . 1951;45:61-68.Crossref 9. So SY, Lam WK, Yu DYC. Rapid diagnosis of suspected pulmonary tuberculosis by fiberoptic bronchoscopy . Tubercle . 1986;89:727-730. 10. Jokinen K, Palva T, Nuutinen J. Bronchial findings in pulmonary tuberculosis . Clin Otolaryngol . 1977;2:139-148.Crossref 11. Rothstein E. Pulmonary tuberculosis involving the lower lobes . Am Rev Tuberc . 1949;59:39-49. 12. Pratti Johnson JH. Observation on lower lobe tuberculosis . Br J Dis Chest . 1959;53:385-389.Crossref 13. Tse CY, Natkunam R. Serious sequelae of delayed diagnosis of endobronchial tuberculosis . Tubercle . 1988;69:213-216.Crossref 14. Ip MSM, So SY, Lam WK, Mok CK. Endobronchial tuberculosis revisited . Chest . 1986;89:727-730.Crossref 15. Smith LS, Schillaci RF, Sarlin RF. Endobronchial tuberculosis: serial fiberoptic bronchoscopy and natural history . Chest . 1987;91:644-647.Crossref 16. Albert RK, Petty TL. Endobronchial tuberculosis progressing to bronchial stenosis: fiberoptic bronchoscopic manifestations . Chest . 1976;70:537-539.Crossref 17. Gordon BL, Charr R, Sokolof MJ. Basal pulmonary tuberculosis: results of treatment . Am Rev Tuberc . 1944;49:432-436. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

The Value of Roentgenographic and Fiberbronchoscopic Findings in Predicting Outcome of Adults With Lower Lung Field Tuberculosis

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References (17)

Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1991.00400080079014
Publisher site
See Article on Publisher Site

Abstract

Abstract Proper antituberculosis chemotherapy may not prevent occurrence or progression of endobronchial involvement in patients with pulmonary tuberculosis. We previously reported a higher incidence of endobronchial involvement in adults with lower lung field tuberculosis (LLFTB). We evaluated the value of roentgenographic and fiberbronchoscopic findings in predicting the outcome of adults with LLFTB after 9 months of antituberculosis chemotherapy. The most common change on chest roentgenograms among 101 patients with LLFTB was consolidation, followed by cavitary lesion, lung collapse, and solitary mass. Intrathoracic lymphadenopathy (hilar and/or mediastinal lymphadenopathy) was found in 12 cases. Sputum smear for acidfast bacilli was positive in 64 patients, and sputum culture for tuberculous bacilli was positive in 37 of 50 patients. Endobronchial involvement was found in 45 of 63 patients who underwent fiberbronchoscopic examination. Of these 45,18 had ulcerative granuloma, 12 had fibrostenosis, eight had submucosal infiltration, and seven had mucosal redness and swelling. A higher incidence of endobronchial involvement was found in the patients with LLFTB when they presented with roentgenographic findings of pulmonary consolidation, lung collapse, or associated intrathoracic lymphadenopathy. The outcome seemed unfavorable in the patients with LLFTB who presented with roentgenographic findings of lung collapse or pulmonary consolidation, or in those who presented with fiberbronchoscopic findings of fibrostenosis or ulcerative granuloma. Our results show that roentgenographic and fiberbronchoscopic findings are of value in predicting outcome of patients with LLFTB. With proper antituberculosis chemotherapy and close follow-up, fiberbronchoscopy may be clinically indicated in patients with LLFTB to assess the presence and severity of endobronchial involvement. Early surgical intervention can be considered in those with severe endobronchial involvement before serious sequelae occur. (Arch Intern Med. 1991;151:1581-1583) References 1. Segarra F, Sherman DS, Rodriguez-Aguero J. Lower lung field tuberculosis . Am Rev Respir Dis . 1963;87:37-40. 2. Parmar MS. Lower lung field tuberculosis . Am Rev Respir Dis . 1967;96:310-313. 3. Berger HW, Granada MG. Lower lung field tuberculosis . Chest . 1974;65:522-526.Crossref 4. Hamilton CE, Fredd H. Lower lung field tuberculosis: a review . JAMA . 1935;105:427-430.Crossref 5. Chang SC, Lee PY, Perng RP. Lower lung field tuberculosis . Chest . 1987;91:230-232.Crossref 6. Auerbach O. Tuberculosis of the trachea and major bronchi . Am Rev Tuberc . 1949;60:604-620. 7. Salkin D, Cadden AV, Edson RC. The natural history of tuberculous tracheobronchitis . Am Rev Tuberc . 1943;47:351-359. 8. Smart J. Endobronchial tuberculosis . Br J Dis Chest . 1951;45:61-68.Crossref 9. So SY, Lam WK, Yu DYC. Rapid diagnosis of suspected pulmonary tuberculosis by fiberoptic bronchoscopy . Tubercle . 1986;89:727-730. 10. Jokinen K, Palva T, Nuutinen J. Bronchial findings in pulmonary tuberculosis . Clin Otolaryngol . 1977;2:139-148.Crossref 11. Rothstein E. Pulmonary tuberculosis involving the lower lobes . Am Rev Tuberc . 1949;59:39-49. 12. Pratti Johnson JH. Observation on lower lobe tuberculosis . Br J Dis Chest . 1959;53:385-389.Crossref 13. Tse CY, Natkunam R. Serious sequelae of delayed diagnosis of endobronchial tuberculosis . Tubercle . 1988;69:213-216.Crossref 14. Ip MSM, So SY, Lam WK, Mok CK. Endobronchial tuberculosis revisited . Chest . 1986;89:727-730.Crossref 15. Smith LS, Schillaci RF, Sarlin RF. Endobronchial tuberculosis: serial fiberoptic bronchoscopy and natural history . Chest . 1987;91:644-647.Crossref 16. Albert RK, Petty TL. Endobronchial tuberculosis progressing to bronchial stenosis: fiberoptic bronchoscopic manifestations . Chest . 1976;70:537-539.Crossref 17. Gordon BL, Charr R, Sokolof MJ. Basal pulmonary tuberculosis: results of treatment . Am Rev Tuberc . 1944;49:432-436.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Aug 1, 1991

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