Chronic Infectious Pulmonary Changes Simulating Tuberculosis in the Older Age Group

¹ Chief, Medical Division II and Assistant to the Medical Director, Berthold S. Pollak Hospital for Chest Diseases, Jersey City, New Jersey.

Bronchiectasis, particularly when untreated, may result after a period of time in the development of rather widespread anatomical changes such as emphysema, fibrosis, chronic pneumonitis, adhesive pleurisy. Cystically dilated bronchi and emphysematous areas may be mistaken for pulmonary cavitation on the roentgenogram of the chest and lead to a diagnosis of tuberculosis, especially when these shadows appear in the upper lung fields.

Increasing medical attention is being placed today on the care of the chronically ill and the older age group in the population. Among the latter, pulmonary tuberculosis has shown an increased incidence. The late complications of bronchiectasis mentioned above, may simulate tuberculosis (particularly the old chronic fibroid type). This report presents the clinical, radiological and pathological findings in three elderly patients who were diagnosed on admission as tuberculous. All of them revealed extensive pulmonary damage of a non-specific character secondary to bronchiectasis. The differential diagnostic problem is a frequent and important one, but not always an easy one. The clinical history and the search for tubercle bacilli are significant aids. The availability of an increasing spectrum of antibiotics to combat infection, and the use of broncho-dilator drugs for bronchospasm, may be helpful adjuvants in the symptomatic relief of these older individuals who have essentially irreversible pulmonary changes.