Smith L S, Schillaci R F, Sarlin R F
Chest. 1987 May;91(5):644-7. doi: 10.1378/chest.91.5.644.
Endobronchial tuberculosis in the preantibiotic era was considered a complication of advanced post-primary disease. Bronchial mucosa adjacent to parenchymal cavities was bathed in infectious sputum, resulting in implantation. Effective antituberculosis drug therapy has reduced childhood exposure, resulting in an increase in adult primary tuberculosis with unusual clinical and roentgenographic presentations. We studied four adults with endobronchial tuberculosis who presented with unusual lobe involvement mimicking bronchogenic carcinoma. Fiberoptic bronchoscopy illustrated the range of endobronchial appearances, including evolution of mucosal ulcer to hyperplastic polyp and bronchostenosis. Complete fibrostenosis with lobar atelectasis was observed in one patient, and an eroding tuberculous lymph node in another. In the current era, endobronchial tuberculosis is more likely to be discovered in adults with progressive primary tuberculosis who have non-cavitary lower lung field infiltrates. Bronchial mucosal ulceration can result from submucosal lymphatic spread of organisms from adjacent parenchymal disease, as well as implantation.
在抗生素时代之前，支气管内膜结核被认为是晚期原发性后疾病的一种并发症。与实质空洞相邻的支气管黏膜被感染性痰液浸润，从而导致植入。有效的抗结核药物治疗减少了儿童时期的接触，导致成人原发性结核病增加，其具有不寻常的临床和X线表现。我们研究了4例支气管内膜结核成人患者，他们表现出不寻常的肺叶受累，类似支气管源性癌。纤维支气管镜检查显示了支气管内表现的范围，包括黏膜溃疡演变为增生性息肉和支气管狭窄。在1例患者中观察到完全纤维性狭窄伴肺叶肺不张，在另一例患者中观察到侵蚀性结核性淋巴结。在当前时代，支气管内膜结核更有可能在患有进行性原发性结核病且下肺野有非空洞性浸润的成人中被发现。支气管黏膜溃疡可由邻近实质疾病的病原体经黏膜下淋巴扩散以及植入引起。
