Endobronchial Tuberculosis in Children

¹ The Department of Otolaryngology of New York University Post-Graduate Medical School and the Department of Pediatrics of New York University College of Medicine and from the Otolaryngology Service and the Chest Clinic of the Children's Medical Service of Bellevue Hospital, New York City.

The endoscopic findings in a series of cases of endobronchitis associated with primary tuberculosis are presented to emphasize their importance in diagnosis and prognosis.

Forty-three children with endobronchial disease were observed. The one case associated with reinfection pulmonary tuberculosis responded promptly to streptomycin therapy. In the remaining 42 cases, where the endobronchial disease was associated with primary pulmonary tuberculosis, no definite evidence of the effective use of streptomycin therapy was obtained.

The most common symptom suggesting endobronchial disease was persistent cough, sometimes paroxsymal or brassy in character. Wheezing was a complaint in one-fourth of the cases. More than one-quarter of the cases had no symptoms suggesting tuberculous involvement of the bronchi. Dullness and diminished breath sounds over a localized pulmonic area were the most common physical signs. A persistent wheeze was heard in about one-third of the patients.

X-ray films of 37 of the 42 patients showed homogeneous shadows involving lobes or segments and the other five showed obstructive emphysema.

Bronchoscopy could be done safely and repeatedly because of a new technique of anesthesia with surital and local pontocaine.

Criteria for bronchoscopy in children with primary pulmonary tuberculosis were cough, wheeze, sudden increase in x-ray shadows around a previously stable primary focus, an x-ray shadow suggesting obstruction or obstructive emphysema or a report of persistently positive cultures from gastric washings in a child without significant findings on x-ray film or physical examination.

A pattern of the pathogenesis of endobronchial disease associated with primary tuberculosis emerges as a result of repeated bronchoscopies; bronchial compression without mucosal involvement may precede endobronchial disease. Edema and inflammation may precede ulceration and granulation; erosion of the bronchial wall may follow; caseous polyps may develop and ultimately stenosis of a bronchus.

Bronchiectasis has already been proved by bronchogram in five of the 42 cases and is suspected in 18 more.