Tuberculous Tracheobronchitis

¹ Sanatorium, Texas

1) About eleven per cent of cases of tuberculosis of the lung parenchyma are complicated by tuberculous tracheobronchitis.

2) Acute endobronchitis may be of the ulcerative type, the hyperplastic type or a mixture of both. The smooth, fibrostenotic lesion represents the chronic stage.

3) The problem of tuberculous tracheobronchitis is largely one of mechanical obstruction and improper drainage of secretions.

4) The chief symptoms are cough, often severe and paroxysmal, wheezing, asthma-like attacks, fever of an intermittent type and dyspnoea.

5) The significant physical signs are rhonchi and wheezing, plus signs of atelectasis in cases with this complication.

6) The most common x-ray findings are those of atelectasis, and check-valve or balloon cavity with a fluid level.

7) The diagnosis can be made with certainty only by bronchoscopy. A negative bronchoscopic examination does not eliminate the possibility of disease of the smaller bronchi.

8) As a general rule the treatment of pulmonary tuberculosis complicated by endobronchitis without stenosis should be that of a similar lesion not so complicated; if ulceration is present, local treatment with 30 per cent silver nitrate is of additional benefit. For cases complicated by stenotic bronchial lesions thoracoplasty is the procedure of choice; local treatment through the bronchoscope of the stenotic lesion itself is often necessary as a supplementary or complementary procedure. Aspiration and drainage of blocked cavities may be indicated before, during or after thoracoplasty. Pneumothorax in the treatment of tuberculosis complicated by stenotic bronchial lesions gives disappointing results in the great majority of cases and its use is not without danger.