Hoheisel G, Teschler H, Chan B K, Chan C H, Luk W K, Sun A J, Costabel U, Konietzko N
Abt. Pneumologie, Ruhrlandklinik Essen.
Pneumologie. 1994 Nov;48(11):788-92.
To determine the value of chest roentgenographic findings in the diagnosis and therapy of endobronchial tuberculosis we analysed roentgenograms of 41 patients with endoscopically confirmed tuberculous involvement of the intrathoracic airways. 40 patients had infiltrates typical for pulmonary tuberculosis predominantly in the upper lobes. Signs of diminished air entry in form of collapse or consolidations were found in 52%. 10 patients had cavities and two had a destroyed lung. In only one patient the chest roentgenogram was completely normal demonstrating a case of isolated endobronchial tuberculosis. During antituberculosis drug therapy radiological signs improved in 38 of 41 patients, but in more than half of the cases stenoses persisted as verified by bronchoscopy. We conclude that endobronchial tuberculosis is usually accompanied by lung parenchyma involvement and that roentgenological findings are characterised by signs of pulmonary tuberculosis in most cases. A normal chest roentgenogram does not exclude endobronchial tuberculosis. Despite roentgenographic improvement during therapy tracheobronchial stenoses may persist. These findings justify to perform early fibreoptic bronchoscopy. Sputum conversion during the clinical course may indicate the most appropriate time for this examination.
为了确定胸部X线检查结果在支气管内膜结核诊断和治疗中的价值,我们分析了41例经内镜证实有胸内气道结核累及患者的X线片。40例患者有典型的肺结核浸润,主要在上叶。52%的患者有以肺不张或实变形式出现的气道进入减少的征象。10例患者有空洞,2例有肺毁损。仅1例患者胸部X线片完全正常,显示为孤立性支气管内膜结核病例。在抗结核药物治疗期间,41例患者中有38例的放射学征象有所改善,但经支气管镜检查证实,超过半数病例的狭窄持续存在。我们得出结论,支气管内膜结核通常伴有肺实质受累,在大多数情况下,X线检查结果以肺结核征象为特征。胸部X线片正常并不能排除支气管内膜结核。尽管治疗期间X线检查有改善,但气管支气管狭窄可能持续存在。这些发现证明应尽早进行纤维支气管镜检查。临床过程中的痰菌转阴可能提示进行该项检查的最合适时间。