支气管色素沉着纤维化合并支气管内膜结核3例并文献复习

The diagnosis of bronchial anthracofibrosis combined with endobronchial tuberculosis

目的分析3例支气管色素沉着纤维化合并支气管内膜结核。方法3例支气管色素沉着纤维化合并支气管内膜结核的病史特征、气管镜下表现及病理特征等进行分析,并结合文献加以总结。结果(1)气管镜下表现为支气管黏膜有不同程度的黑色素沉着,相应的支气管有较明显的支气管狭窄或闭塞,黑色素沉着程度与支气管狭窄程度无关。(2)肺CT:多表现为叶、段肺实变影,伴或不伴纵隔、肺门淋巴结肿大或钙化,易误诊为肺癌。(3)病理表现为支气管粘膜慢性炎症、或肉芽肿伴黑色素沉着,支气管周围严重纤维化。(4)支气管色素沉着纤维化多伴随有活动性肺结核。结论:支气管色素沉着纤维化和活动性结核或陈旧性肺结核密切相关,目前国内对本病的诊断尚罕见。

Objective To explore the clinical manifestation of bronchial anthraeofibrosis, and to determine the association of anthraeofibrosis with endobronehial tuberculosis. Method The clinical features, radiologieal findings, bronehoseopie natures, and histological characteristics of three cases of bronchial anthracofibrosis associated with endobronchial tuberculosis diagnosed in the Aifforce General Hospital were analyzed and summarized, and the relevant literature was reviewed. Results Patients with bronchial anthracofibrosis had no exposure to mining or industry and no history of smoking. Clinically, patients were presented with fever, chronic cough with variable amounts of sputum and progressive dyspnea. Another complaints were fatigue, chest diacomfort, and hemoptysis. One patient was asymptomatic. The most common physical finding was wheezing sound on auscultation. The principal finding of bronchoscopy was anthracotic pigmentation of bronchial mucosa with or without bronchial stenosis. The severity of bronchial narrowing was variable in each bronchus and had no correlation with the degree of anthracotic pigmentation. CT of chest revealed lobal or segmental consolidation, segmental or subsegmental atelectasis, calcified and unealeified lymph nodes. Pathologic examination of the specimens obtained by bronehoscopie biopsy showed chronic mucosal inflammation, or granulomatous inflammation, dense mucosal fibrosis with anthracotic pigmentation. Conclusion The report of the bronchial anthraeofibrosis associated endobronehial tuberculosis is rare. The precise cause of bronchial anthraeofibrosis is unknown. However, bronchial anthraeofibresis is strongly associated with active or old endobronehial tuberculosis.