Department of Respiratory Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Chin Med J (Engl). 2013 Jul;126(14):2641-6.
Bronchial anthracofibrosis (BAF) has been defined as a luminal narrowing associated with anthracotic pigmentation on bronchoscopy without a relevant history of pneumoconiosis or smoking. The aim of the study is to study the clinical features and imaging manifestations of BAF, and to promote the awareness of this disease.
Between October 2006 and January 2012, 15 patients were diagnosed at our department as BAF that showed a narrowing or obliteration of lobar or segmental bronchi with anthracotic pigmentation in the overlying mucosa on bronchoscopy. The medical records including clinical features, imaging manifestations, electronic bronchoscopic findings, and pathological features were analysed, and the literature was reviewed.
A total of 15 patients were analyzed; 13 were female (86.7%) and two were male (13.3%) and the age range was from 62 to 86 years with a mean age of 74.5 years. Three cases (20.0%) had a history of tuberculosis. The most common clinical symptoms of BAF were cough (100%), expectoration (73.3%), dyspnea (60.0%), and fever (46.7%). Twelve cases displayed mild to moderate obstructive ventilatory dysfunction. In the electronic bronchoscopic evaluation, the most common findings were black bronchial mucosal pigmentation, bronchial stenosis, bronchial occlusion, and bronchial mucosal folds. Pathological evaluation revealed chronic inflammation of the bronchial mucosa, submucosal carbon particle deposition, and mucosal or submucosal fibrosis. Chest CT scans showed that 15 patients had bronchial stenosis or obstruction (direct signs) with the right middle lobe being the most common site (11 cases, 73.3%). The indirect sign was mainly the presence of bronchial obstructive diseases (including secondary infection), represented by 11 cases of pulmonary consolidation (73.3%), seven cases of atelectasis (46.7%), and five cases of nodules (33.3%). The CT mediastinal window showed bronchial lymph node lesions, mediastinal lymph node calcification (12 cases, 80.0%), and enlargement of multiple mediastinal lymph nodes.
The diagnosis of BAF was mainly based on bronchoscopic evaluation. Its pathogenesis is currently unclear, although it may be related to tuberculosis or bio-fuel inhalation. The diagnosis of BAF has important clinical significance, and improved awareness of this disease will contribute to prevention of unnecessary thoracotomies.
支气管炭末沉着纤维性狭窄（BAF）定义为支气管镜下可见有管腔狭窄，同时伴有炭末沉着，但无相关的尘肺或吸烟史。本研究旨在探讨 BAF 的临床特征和影像学表现，提高对该病的认识。
2006 年 10 月至 2012 年 1 月，我院呼吸科诊断为 BAF 的患者共 15 例，均表现为支气管镜下肺叶或肺段支气管狭窄或闭塞，伴黏膜表面炭末沉着。分析其临床资料、影像学表现、电子支气管镜检查结果及病理学特征，并复习文献。
共分析 15 例患者，其中男 2 例（13.3%），女 13 例（86.7%）；年龄 62~86 岁，平均年龄 74.5 岁。3 例（20.0%）有肺结核病史。BAF 的主要临床症状为咳嗽（100%）、咳痰（73.3%）、呼吸困难（60.0%）和发热（46.7%）。12 例患者表现为轻中度阻塞性通气功能障碍。电子支气管镜检查发现，最常见的表现为黑色支气管黏膜色素沉着、支气管狭窄、支气管闭塞和支气管黏膜皱襞。病理评估显示，支气管黏膜慢性炎症，黏膜下碳颗粒沉积，黏膜或黏膜下纤维化。胸部 CT 扫描显示，15 例患者存在支气管狭窄或阻塞（直接征象），其中以右中叶最常见（11 例，73.3%）。间接征象主要为支气管阻塞性疾病（包括继发感染），包括 11 例肺实变（73.3%）、7 例肺不张（46.7%）和 5 例结节（33.3%）。CT 纵隔窗显示支气管淋巴结病变，纵隔淋巴结钙化（12 例，80.0%）和多个纵隔淋巴结肿大。
BAF 的诊断主要基于支气管镜评估。其发病机制目前尚不清楚，可能与肺结核或生物燃料吸入有关。BAF 的诊断具有重要的临床意义，提高对该病的认识有助于避免不必要的开胸手术。
