Elango Ragavi, Kailash Ashwin, Verma Ghanshyam, Rudhramoorty Prasana
Respiratory Medicine, Sree Balaji Medical College and Hospital, Chennai, IND.
Cureus. 2024 Jul 26;16(7):e65411. doi: 10.7759/cureus.65411. eCollection 2024 Jul.
Silico-tuberculosis is the combination of silicosis and tuberculosis (TB). Symptoms of TB such as dyspnea, cough, and hemoptysis may precede the diagnosis of an endo-bronchial mass lesion on chest imaging. Among workers who were exposed to silica, TB was more common, and experiments indicated that silica inhibits alveolar macrophage activity and severe exposure induces apoptosis. Endobronchial neoplasms, which are tumors primarily affecting the bronchial lumen, are uncommon and may show up in a wide variety of different ways pathologically. Cough, chest discomfort, wheezing, hemoptysis, recurrent pneumonia, and weight loss are common complaints from people with endobronchial tumors. The requirement for additional bronchoscopy and imaging examination is raised when symptoms such as hemoptysis and obstructive pneumonia are present. Endobronchial silicosis lesions are uncommon and develop as a result of broncho lithiasis, the endoluminal erosion of peri bronchial adenopathy, or local bronchial wall silica-induced fibrosis. Endobronchial TB can present in a varied manner, diagnosis is often challenging as there is no specific radiological feature, and sputum acid-fast bacilli several times come out negative. However, a bronchoscopy with or without biopsy is a useful investigation in these cases. The following case is a rare manifestation of endobronchial TB as it mimicked malignancy, describing the difficulties in diagnosis and treating a patient who had both silicosis and endobronchial TB.
硅沉着病合并肺结核是矽肺和肺结核(TB)的组合。肺结核的症状,如呼吸困难、咳嗽和咯血,可能在胸部影像学上诊断出支气管内肿块病变之前出现。在接触二氧化硅的工人中,肺结核更为常见,实验表明二氧化硅会抑制肺泡巨噬细胞活性,严重接触会诱导细胞凋亡。支气管内肿瘤主要影响支气管腔,较为罕见,在病理上可能以多种不同方式出现。咳嗽、胸部不适、喘息、咯血、反复肺炎和体重减轻是支气管内肿瘤患者的常见主诉。当出现咯血和阻塞性肺炎等症状时,需要进一步进行支气管镜检查和影像学检查。支气管内矽肺病变并不常见,是由支气管结石、支气管周围腺病的腔内侵蚀或局部支气管壁二氧化硅诱导的纤维化所致。支气管内肺结核的表现形式多样,由于没有特定的放射学特征,诊断往往具有挑战性,痰涂片抗酸杆菌多次呈阴性。然而,在这些病例中,进行或不进行活检的支气管镜检查都是一种有用的检查方法。以下病例是支气管内肺结核的一种罕见表现,因为它酷似恶性肿瘤,描述了一位患有矽肺和支气管内肺结核患者的诊断和治疗困难。