Tuberculous bronchial stenosis: CT findings in 28 cases

Bronchial stenosis is a complication of tuberculous parenchymal or lymph node disease and may adversely affect its treatment. Findings on plain radiographs may be nonspecific or simulate malignancy. The purpose of this study was to evaluate the role of CT in diagnosing this abnormality. We reviewed the findings in 28 patients who underwent CT to evaluate bronchial stenosis proved by bronchoscopy. Eighteen had evidence of tuberculosis on bronchial biopsy. In the other 10 the biopsy findings were nonspecific, but tuberculous lesions were elsewhere in the thorax. Twelve patients (43%) had CT findings of concentric bronchial stenosis, uniform thickening of the bronchial wall, and involvement of a long segment of the bronchi. In 14 patients (50%), CT showed obliteration of bronchial outlines by adjacent lymphadenopathy, parenchymal consolidation, and absence of intraluminal air. In two patients, the abnormality was not visible on CT. Our experience shows that CT is useful for identifying bronchial stenosis caused by tuberculosis. However, the findings vary, and in more than half of the patients concentric narrowing and uniform thickening of the bronchi are not seen.     

支气管内膜结核的CT表现

目的　分析支气管内膜结核 (EBTB)的CT表现 ,提高对EBTB的认识。资料与方法　回顾分析 18例经纤维支气管镜、病理证实的EBTB的胸部CT表现 ,探讨支气管本身的异常以及肺实质、淋巴结和胸膜改变。结果　共 2 1处支气管受累 ,右肺多于左肺 ,累及下叶最多。支气管壁增厚 16处 ,管腔狭窄 13处 ,累及较长段者 (>3cm) 10处 ,管壁增厚、局部管腔扩大 5处。 5例继发肺不张 ,11例并存支气管播散灶。所有患者肺野内均可见陈旧性肺结核灶 ,8处病灶为活动性 ,15例并发胸膜病变。肺门纵隔淋巴结肿大 9例。结论　较长段的支气管壁中心性增厚为EBTB的主要表现 ,多数并存肺实质和胸膜病变 ,淋巴结环形强化为其特征     

Thoracic sequelae and complications of tuberculosis.

Pulmonary tuberculosis is caused by Mycobacterium tuberculosis when droplet nuclei laden with bacilli are inhaled. In accordance with the virulence of the organism and the defenses of the host, tuberculosis can occur in the lungs and in extrapulmonary organs. A variety of sequelae and complications can occur in the pulmonary and extrapulmonary portions of the thorax in treated or untreated patients. These can be categorized as follows: (a) parenchymal lesions, which include tuberculoma, thin-walled cavity, cicatrization, end-stage lung destruction, aspergilloma, and bronchogenic carcinoma; (b) airway lesions, which include bronchiectasis, tracheobronchial stenosis, and broncholithiasis; (c) vascular lesions, which include pulmonary or bronchial arteritis and thrombosis, bronchial artery dilatation, and Rasmussen aneurysm; (d) mediastinal lesions, which include lymph node calcification and extranodal extension, esophagomediastinal or esophagobronchial fistula, constrictive pericarditis, and fibrosing mediastinitis; (e) pleural lesions, which include chronic empyema, fibrothorax, bronchopleural fistula, and pneumothorax; and (f) chest wall lesions, which include rib tuberculosis, tuberculous spondylitis, and malignancy associated with chronic empyema. These varieties of radiologic manifestations can mimic other disease entities. Therefore, recognition and understanding of the radiologic manifestations of the thoracic sequelae and complications of tuberculosis are important to facilitate diagnosis.     

结核性支气管狭窄61例的CT表现

目的 提高对结核性支气管狭窄CT表现的认识。资料与方法 回顾性分析61例结核性支气管狭窄的CT扫描资料。为了比较，同时复习33例经病理证实的中心型肺癌CT片。结果 CT片上，61例共显示狭窄支气管128支，包括右侧72支(56．3％)和左侧56支(43．7％)。其中37例(60．7％)显示2支以上的狭窄支气管，15例(24．6％)主、叶、段多支支气管同时受累。支气管狭窄表现为向心性管状狭窄38例(62．3％)、漏斗状狭窄15例(24．6％)和闭塞8例(13．1％)。支气管狭窄程度表现为轻度34例(55．7％)、中度19例(31．2％)和重度8例(13．1％)。狭窄腔边缘显示不规则30例(49．2％)，光滑23例(37．7％)。结论 轻或中度向心性管状或漏斗状狭窄，狭窄段较长或主、叶、段多支支气管受累是结核性支气管狭窄常见的CT表现。     

CT findings of pulmonary tuberculosis presenting as segmental consolidation.

PURPOSE: The purpose of our study was to determine specific CT findings of tuberculous pneumonia presenting as segmental or lobar consolidation along with a pathologic review of specimens with similar radiographic patterns. METHOD: CT findings of 45 cases of proven tuberculous pneumonia and 21 proven nontuberculous pneumonia were compared. Pathologic findings of five surgically resected tuberculous pneumonia cases were also investigated. The presence of fluid bronchogram (linear, branching shadow of fluid attenuation) and inner low attenuation/cavitation in the area of consolidation, luminal dilatation, and wall thickening of proximal bronchi were the main points sought on CT scan. In addition, the presence of bronchogenic dissemination, lymph node enlargement, and pleural lesions was also checked for in the unaffected area of both lungs. RESULTS: The following bronchial changes were seen in the tuberculous pneumonia and nontuberculous pneumonia groups, respectively: fluid bronchogram in 68.9 and 23.8% (p < 0.05), bronchial luminal dilatation in 60.0 and 23.8% (p < 0.05), and bronchial wall thickening of the proximal airway leading to the area of consolidation in 52.8 and 7% (p < 0.05). Bronchogenic dissemination outside the consolidation appeared in 88.9 and 52.4% (p < 0.05), respectively. In the tuberculous pneumonia group, lymph node enlargement and pleural reaction were seen in 55.6 and 35.6%, respectively, but in 42.9 and 57.1% in the nontuberculous pneumonia group (p > 0.05). Histologically, tuberculous pneumonia showed either bronchioles containing inflammatory exudates and submucosal granuloma or alveoli containing aggregates of alveolar macrophages or cellular debris. CONCLUSION: Fluid bronchogram in the area of homogeneous consolidation, bronchial luminal dilatation, and bronchial wall thickening of the proximal airway were the bronchial changes more significantly prominent in the tuberculous pneumonia group. We suspect that these findings may represent tuberculous bronchitis in small airways.     

Clinical evaluation of stent placement for tracheal and bronchial stenosis]

Expandable metallic stents were successfully introduced in 7 patients, including 4 with left main bronchial stenosis caused by bronchopulmonary tuberculosis, 2 with main bronchial stenosis caused by lung cancer and one with tracheal stenosis caused by adenoid cystic carcinoma. The length of stenosis was 1.5-5 cm. The stents were 1.5-2.5 cm long with barbs, and their full expanded diameter was 1.5 cm. Balloon dilatation was performed before stenting in all cases. The stents were inserted by using a 10-12 Fr catheter. In all patients except the one with tracheal stenosis, stents were introduced under local anesthesia without any difficulties. No migration of stents occurred. After stent placement, there were no respiratory difficulties, and radionuclide lung perfusion scan and chest radiographic findings such as lung atelectasis showed marked improvement in three cases. Combined therapy of stent placement and bronchial arterial infusion chemotherapy showed marked effectiveness in one case with lung cancer. Expandable metallic stents were very useful in eliminating tracheobronchial stenosis symptoms.     

Endoscopical methods in the differential diagnosis of tuberculosis and cancer of the respiratory system

For 25 years (1986-2011) in endoscopy unit of the branch of the 1 FBU "3 TSVKG Russian Ministry of Defense n. a. A.A. Vishnevskiy--" initially examined 18 169 patients admitted on the various forms of pulmonary tuberculosis. In the bronchial study tuberculosis of bronchus was diagnosed in 1544 patients, representing 8.5% of all TB patients. Complicated bronchial tuberculosis (infiltrative-ulcerative and broncho-fistulezny TB) were diagnosed in 382 (24.8%) patients. Neoplastic process in bronchi was detected in 145 (0.8%) patients, including the central cancer was found in 109, peripheral--at 36. An increase in tuberculosis and cancer of the respiratory system requires medical endoscopists to targeted search for endoscopic studies, not only the specific features of tuberculous bronchial lesions, but also the cancer process in them. In the case of detection of pathological changes in the pleura and lung parenchyma should be preferred thoracoscopy.     

Manifestations radiologiques de la tuberculose pulmonaire

Pulmonary tuberculosis (TP) is a common worldwide lung infection. The radiological features show considerable variation, but in most cases they are characteristic enough to suggest the diagnosis. Classically, tuberculosis is divided into primary, common in childhood, and postprimary, usually presenting in adults. The most characteristic radiological feature in primary tuberculosis is lymphadenopathy. On enhanced CT, hilar and mediastinal nodes with a central hypodense area suggest the diagnosis. Cavitation is the hallmark of postprimary tuberculosis and appears in around half of patients. Patchy, poorly defined consolidation in the apical and posterior segments of the upper lobes, and in the superior segment of the lower lobe is also commonly observed. Several complications are associated with tuberculous infection, such as hematogenous dissemination (miliary tuberculosis) or extension to the pleura, resulting in pleural effusion. Late complications of tuberculosis comprise a heterogeneous group of processes including tuberculoma, bronchial stenosis bronchiectasis, broncholithiasis, aspergilloma, bronchoesophageal fistula and fibrosing mediastinitis. Radiology provides essential information for the management and follow-up of these patients and is extremely valuable for monitoring complications.     

Dysphagia due to mediastinal fibrosis in advanced pulmonary tuberculosis

Dysphagia in patients with pulmonary tuberculosis may be due to tuberculous esophagitis or compression of the esophagus by enlarged mediastinal lymph nodes or mediastinal fibrosis. We studied the clinical and radiologic findings in nine patients with advanced pulmonary tuberculosis who presented with dysphagia. In each patient, dysphagia first occurred while the patient was on antituberculous therapy. Chest radiographs in each case showed extensive tuberculous disease of the lung, affecting especially the left upper lobe. In addition, dense mediastinal pleural fibrosis was seen along the medial aspects of the upper thorax. Tomograms did not show mediastinal lymph node enlargement. Barium esophagograms showed extrinsic compression and various degrees of narrowing of the supracarinal part of the esophagus. No mucosal abnormality was seen on esophagoscopy. On the basis of these findings, the compression of the esophagus in these patients was attributed solely to tuberculous mediastinal fibrosis. The dysphagia remained constant in all patients except one, in whom worsening dysphagia improved after balloon dilatation. We conclude that mediastinal fibrosis is a significant cause of dysphagia in patients with advanced pulmonary tuberculosis.     

结核性支气管狭窄的CT表现

目的分析结核性支气管狭窄的CT表现，提高诊断准确率。方法回顾性分析36例经纤维支气管镜和病理组织学证实的结核性支气管狭窄的胸部CT表现。并与23例经病理证实的中心型肺癌CT表现进行比较。结果36例共84处支气管受累，其中，23例显示2支以上的支气管受累。右肺（52处）多于左肺（32处）；多数表现为支气管壁增厚和管腔变窄。管腔轻度狭窄42处，中度狭窄24处，重度狭窄18处；向心性狭窄50处。累及较长段者（大于3cm）48处，9例继发肺不张。所有患者肺野内均可见肺结核灶，28例病灶为活动性，30例并发胸膜病变。肺门与纵隔淋巴结肿大19例。结论较长段的支气管壁增厚管腔轻、中度向心性狭窄为结核性支气管狭窄的主要表现，同时，CT所显示的多支支气管受累及肺实质和胸膜病变并存，有助于本病的确诊。     

气管、支气管内膜结核HRCT价值及临床意义

目的 :探讨HRCT对气管、支气管内膜结核的诊断价值及临床意义。方法 :对 3 2例诊断明确的住院患者行胸部HRCT扫描 ,结合纤维支气管镜检查情况 ,重点观察病变气道内壁及管腔的形态变化以及其病变远侧肺实质的病变情况。结果 :气管、支气管壁病变检出率为 73 .92 % ,其中管壁轻度增厚 5 4.3 5 % ,明显增厚 19.5 7% ;气道管腔形态改变检出率为 67.3 9% ,其中管腔狭窄 <5 0 % 41.3 0 % ,>5 0 % 19.5 7% ,管腔闭塞 6.5 2 %。同时观察到气管、支气管周围及纵隔淋巴结肿大 7例 ,病变支气管远侧管腔内粘液栓 12例 ,管腔局限性扩张 5例 ,小叶性肺气肿 18例 ,肺不张 2例 ,肺内结核病灶 3 9例。结论 :HRCT作为无创性检查 ,在观察气道病变的部位和范围、气道病变与肺内病变的关系、危重患者纤维支气管镜检查前的定位准备及估计预后均有重要的临床意义。     

Radiological manifestations of pulmonary tuberculosis

Pulmonary tuberculosis (TB) is a common worldwide lung infection. The radiological features show considerable variation, but in most cases they are characteristic enough to suggest the diagnosis. Classically, tuberculosis is divided into primary, common in childhood, and postprimary, usually presenting in adults. The most characteristic radiological feature in primary tuberculosis is lymphadenopathy. On enhanced CT, hilar and mediastinal nodes with a central hypodense area suggest the diagnosis. Cavitation is the hallmark of postprimary tuberculosis and appears in around half of patients. Patchy, poorly defined consolidation in the apical and posterior segments of the upper lobes, and in the superior segment of the lower lobe is also commonly observed. Several complications are associated with tuberculous infection, such as hematogenous dissemination (miliary tuberculosis) or extension to the pleura, resulting in pleural effusion. Late complications of tuberculosis comprise a heterogeneous group of processes including tuberculoma, bronchial stenosis bronchiectasis, broncholithiasis, aspergilloma, bronchoesophageal fistula and fibrosing mediastinitis. Radiology provides essential information for the management and follow up of these patients and is extremely valuable for monitoring complications.     

Cutting balloon treatment for recurrent benign bronchial strictures

OBJECTIVE: Benign airway strictures refractory to balloon dilatation or stent placement remain a challenge in interventional radiology. This article describes the successful use of a cutting balloon to treat three cases of recurrent tuberculous bronchial strictures. CONCLUSION: In three patients, cutting balloon dilatation was found to be safe and effective and did not cause complications. Although the dilated lumen showed partial reduction over the 6- to 12-month follow-up, subjective functional symptoms and dyspnea grade improved.     

Pulmonary angiography and embolization for severe hemoptysis due to cavitary pulmonary tuberculosis

Purpose: To identify the role of pulmonary angiography in the diagnosis and treatment of severe hemoptysis due to cavitary pulmonary tuberculosis. Methods: Selective pulmonary angiography was performed on eight patients with severe hemoptysis uncontrolled by previous bronchial and systemic arterial embolization. Results: Three (38%) patients had Rasmussen aneurysms, which were successfully embolized with steel coils. Five patients demonstrated pulmonary arterial hypoperfusion in the diseased lung. Conclusions: We recommend pulmonary angiography in cavitary tuberculous patients with severe hemoptysis who do not respond to systemic arterial embolization. Rasmussen aneurysms are effectively treated by steel coil occlusion.     

Treatment of intracranial atherosclerotic stenoses with balloon dilatation and self-expanding stent deployment (WingSpan)

The endovascular treatment of atherosclerotic intracranial arterial stenoses has previously been based on balloon dilatation or the deployment of a balloon expandable stent. Both methods have advantages (balloon: flexibility; balloon expandable stent: high radial force) and drawbacks (balloon: risk of elastic recoil and dissection; balloon expandable stent: limited flexibility, risk of injury to the vessel due to excessive straightening, overexpansion at ends of stent). A new combination of balloon dilatation, followed by the deployment of a self-expanding microstent has been applied in 15 patients with atherosclerotic arterial stenoses, symptomatic despite medical treatment. An anatomically and clinically adequate result was achieved in all patients. The initial degree of stenosis was 72% (mean). Balloon dilatation resulted in an average residual stenosis of 54% (mean), reduced further to a mean of 38% after stent deployment. Arterial dissection, occlusion of the target artery or symptomatic distal emboli was not encountered. In one patient, a side branch occlusion occurred after dilatation of a M1 stenosis, with complete neurological recovery. All patients were either stable or improved 4 weeks after the treatment. Recurrent TIA did not occur in any patient. Balloon dilatation and subsequent deployment of a self-expandable stent for the treatment of symptomatic intracranial arterial stenoses combines the advantages of both techniques and allows a rapid, clinically effective and technically safe treatment of these frequently challenging lesions.     

结核性渗出性胸膜炎86例临床分析

目的进一步探讨结核性渗出性胸膜炎的临床特点以及与肺实质结核的关系。方法回顾性分析2006年1月-2008年12月收治的86例结核性渗出性胸膜炎住院患者的临床特点、治疗及转归。结果结核性胸膜炎好发于青少年及老年人,最常见症状为发热、胸痛及咳嗽,以单侧淋巴细胞为主型渗出性胸膜炎为主。86例患者中经CT检查观察到合并肺实质损害的有69例,占80．2％,其中42例表现为活动性肺结核影像学特点,占48．8％;最常见为渗出及增殖性病灶,病灶位于上叶者42例,占60．9％。肺内病灶与胸水在同一侧59例,双侧都有病灶8例,二者之和远高于肺内病灶在胸水对侧的2．9％（2／69）（P〈0．05）。经统计学处理对比继发性结核性胸膜炎组与单纯性结核性胸膜炎组发病年龄、PPD阳性率、血清结核抗体阳性率、胸水蛋白含量、胸水细胞数及淋巴细胞数比例无显著性差异（P〉0．05）,两组胸水PCR—TB—DNA检出阳性率分别为81_3％和16．7％,经统计学处理对比差异具有显著性（P〈0．05）。本组病例89．5％采用短程化疗方案2HRZE／4HR、2HRE／4HR抗结核治疗,近期疗效显著。继发性结核性胸膜炎组与单纯性结核性胸膜炎组疗效无明显差异。结论结核性胸膜炎与肺结核关系密切,将其与肺结核一并列入结核病归口管理对象,对控制结核病疫情具有重要意义。     

肾结核的CT诊断

目的探讨肾结核CT扫描的影像特征及其鉴别诊断.材料与方法分析经手术病理证实或临床综合诊断的69例肾结核的CT表现.结果CT反映肾结核病理特征常有(1)肾髓质多发空洞或脓腔形成(88.4%),常呈囊状低密影并围绕肾盂似"花瓣状”排列;(2)肾皮质局部或普遍萎缩变薄(78.3%);(3)肾盂及输尿管壁普遍增厚(65.2%),管腔狭窄或扩张;(4)自髓质空洞壁逐渐出现的点线、蛋壳、球形或肾形钙化(34.8%).而肾脏的体积增大或缩小、外形分叶、积水或积脓及功能损害是常见的继发改变.髓质肾结核常常先侵犯肾上极,再继续波及全肾.结论CT对肾结核的诊断及制定治疗方案具有重要价值,熟悉CT表现并密切结合临床是正确诊断的关键.     

脾结核的影像学诊断（附9例报告）

目的 分析脾结核的影像学诊断价值。材料与方法 9例脾结核屠 经胸部摄片、CT、超声及相关实验室检查,4例病理证实,5例抗结核治疗证实。结果 8例肺部有结核灶,9例脾肿大,7例肝肿大及腹膜后淋巴结肿大,3例脾内有多发低密度灶或回声减低区,合并左肾结核小低密度灶、结核性缩2窄性心包炎各1例及颈淋巴结结核4例。结论 CT、超声检查对脾结核的诊断有价值而无特异性,需结合临床及其他部位结构或结核治疗有铲作出诊断。     

Results of temporary placement of covered retrievable expandable nitinol stents for tuberculous bronchial strictures

Covered retrievable expandable nitinol stents were successfully placed in nine patients with tuberculous bronchial strictures refractory to balloon dilation. Complications included stent migration (n = 1) and tissue hyperplasia at the proximal portion of the stent (n = 2). During the follow-up period (5-52 months), stricture recurred in three of five patients (60%) after temporary stent placement for 2 months, whereas stricture did not recur in the other four patients after temporary stent placement for 6 months. Temporary placement of covered retrievable stents appears to be an effective method for the treatment of patients with tuberculous bronchial strictures refractory to balloon dilation.