Mariotta S, Masullo M, Guidi L, Aquilini M, Pabani R, Bisetti A
Università La Sapienza, Dipartimento Scienze Cardiovascolari e Respiratorie, Osp C. Forlanini, Rome, Italy.
Monaldi Arch Chest Dis. 1995 Oct;50(5):356-9.
In suspected pulmonary tuberculosis (TB), tracheobronchial examination is required for patients with clinical and radiographic features consistent with tuberculosis disease but with negative sputum for Mycobacterium tuberculosis. We report the endoscopic findings of 84 patients who underwent fibreoptic bronchoscopy in recent years, and whose cultures of biological specimens grew M tuberculosis. Cough (86%) and fever (69%) were the most common symptoms, followed by sputum (67%), dyspnoea (30%) and haemoptysis (27%). Chest radiographic abnormalities were mostly localized (60%) with prevalence in the upper lobes; in two cases chest radiography was normal. Sixty two patients (74%) showed endoscopic abnormalities: 1) mucosal inflammation; 2) submucosal granulomas and polyps; and 3) stenoses. They were localized in 58% of patients and diffuse in 42%. Five patients were checked several times during the year following the diagnosis because of a high degree of tracheobronchial involvement. Only one subject recovered, whilst in the other four stenotic sequelae were found. Fibreoptic bronchoscopy confirmed its usefulness in the diagnosis of tuberculosis and in monitoring the course and the outcome of the bronchial tuberculosis involvement.
在疑似肺结核（TB）患者中，对于临床和影像学特征符合结核病但痰涂片结核分枝杆菌阴性的患者，需要进行气管支气管检查。我们报告了近年来84例接受纤维支气管镜检查且生物标本培养出结核分枝杆菌患者的内镜检查结果。咳嗽（86%）和发热（69%）是最常见的症状，其次是咳痰（67%）、呼吸困难（30%）和咯血（27%）。胸部X线异常大多局限（60%），以上叶多见；2例胸部X线检查正常。62例患者（74%）显示内镜异常：1）黏膜炎症；2）黏膜下肉芽肿和息肉；3）狭窄。它们在58%的患者中为局限性，42%为弥漫性。由于气管支气管受累程度高，5例患者在诊断后的一年内接受了多次检查。仅1例患者康复，而其他4例发现有狭窄后遗症。纤维支气管镜检查证实了其在结核病诊断以及监测支气管结核病程和转归方面的有用性。
