Tuberculous bronchial stenosis: Diagnosis and role of interventional bronchoscopy

Abstract

The reported prevalence of tuberculous bronchial stenosis in children is unknown and rarely reported in English-speaking literature. In adult patients with pulmonary tuberculosis, it varies from 40% in an autopsied series in the preantibiotic era to 10% in patients who have undergone routine bronchofibroscopy in modern times. We describe our experience of four cases of confirmed bronchial stenosis due to MTB collected between January 2000 and June 2021 in this case series descriptive study.The diagnosis of bronchial stenosis due to TB was made on flexible bronchoscopy. A TB diagnosis was made if MTB was cultured from respiratory secretions, when Ziehl-Neelsen smear or GeneXpert MTB/RIF test was positive, or if a chest radiograph revealed radiographic features typical of MTB. Bronchial stenosis due to TB is rare even if airway compression is frequently seen. Although an early diagnosis of bronchial stenosis due to TB is difficult on chest X-rays, all children in this series demonstrated parenchymal changes distal to the stenosis ranging from hyperinflation and lobar collaps to bronchiectasis. If bronchial stenosis resulting from TB disease is diagnosed early, balloon dilatation as described in this report, may be an effective and safe intervention, preventing long-term complications such as irreversible lung destruction, that may require pneumonectomy.

Multimodality Endoscopic Approach for Benign Central Airway Stenosis in Pediatric Tuberculosis: A Case Report

“…Studies have suggested an inflation time between 30 and 60 seconds in clinical practice, depending on individual circumstances. 13 …”

“…Studies have suggested an inflation time between 30 and 60 seconds in clinical practice, depending on individual circumstances. 13 Cryotherapy is the use of extreme cold to freeze, destruct and remove abnormal tissue, damaging intracellular organelles, and the cell wall, and in the process trigger the body's repair and regeneration process. 14 Cryotherapy is applicable to bronchial stenosis caused by granuloma formation in the proliferative phase of tracheobronchial TB.…”

Advanced bronchoscopic interventions in pediatric endobronchial tuberculosis—A single center experience

“…Although the exact pathogenesis of EBTB is unknown, possible mechanisms include (1) direct seeding from the parenchymal focus, (2) erosion from a nearby lymph node, (3) hematogenous, or (4) lymphatic spread. 3 With FB, the lesion appears as either mucosal inflammation, ulceration, caseation, tumorous growth, or stenosis, depending on the subtype. 5 Therapeutic targets of EBTB include eradication of TB bacilli and maintaining airway patency.…”

“…Although common in adults, literature is sparse regarding the use of interventional bronchoscopic techniques in pediatric EBTB. 3,4 Here, we present our experience, a series of six cases of EBTB, presenting at various stages that were diagnosed and managed in our tertiary care pediatric pulmonology unit. This is a retrospective descriptive study.…”

“…Data on interventions for pediatric EBTB are limited to case reports and small series. 3,4 Balloon dilatation is often the first intervention in patients with stenotic EBTB. In our Institute, we use a CRE balloon of appropriate size, inserted through the stenotic segment using a rigid bronchoscope.…”