Misdiagnosis reasons and methods of the early definite diagnosis on trachea and bronchial tuberculosis

[Objective] To explore misdiagnosis reasons and methods of early definite diagnosis on trachea and bronchial tuberculosis. [Methods] Clinical symptoms, misdiagnosis reasons and diagnosis methods of 150 patients being misdiagnosed were retrospectively investigated. [Results] The clinical features were non-specific. An activated dry cough was the most common complaint in 75%, and the others were intermittent hemoptysis, fever, dyspnear etc. There were no and/or less clinical poisoning symptoms of tuberculosis. Clinical chest roentgenographic presentations were non-typical. Chest roentgenographic were normal, shape, atelectasis, keratosis pheumonitis, swelling of hitum of lung etc. Lung cancer and atelectasis together were the most common reasons in 49%, pheumonitis in 23.3%, bronchitis in 17.3%, and the others were lung tuberculosis, tuberculous pleuritis, asthma in return. Bronchoscopic findings showed that main pathologic changes included 36.7% granulation, 28% mucosa inflammation, 24% ulceration (or necrosis) and 11.3% cicatricial stenosis. Left lung(49.4%) was more often affected the right, and left bronchi is in the most-22.7%. The disease affected all leaf and segment bronchi. 131 cases (87.3%) were diagnosed by bronchoscopic biopsy; 41 cases (27.3%)were diagnosed by bronchoscopic brushing examination for acid-fast bacillus. [Conclusion] The clinical features, roentgenographic presentations and examination for acid-fast bacillus of trachea and bronchial tuberculosis are non-specific and easy to be misdiagnosed. Clinical doctors have less knowledge of this disease and neglecting or giving up early are the main reasons to be misdiagnosed. Bronchoscopic brushing examination for acid-fast bacillus and bronchoscopic biopsy should be the most reliable and accurate step to get the definite diagnosis, and could be used widely in clinical applications.