Clinical analysis of 12 cases of childhood atypical endobronchial tuberculosis

Objective To analyze the clinical characteristics of atypical endobronchial tuberculosis(EBTB) in children and explore the value of bronchoscopy examination in diagnosis and treatment of this disease. Methods The records of 12 children diagnosed as atypical EBTB in Children's Hospital of Chongqing Medical University from Jan.2008 to Dec.2011 were reviewed, and their medical history, clinical manifestation, imaging and laboratory findings were analyzed.They all had fiberoptic bronchoscopy and bronchoalveolar lavage.Four patients had bronchial lining pathologic biopsy.Bronchoscope findings of the 12 children were analyzed. Results The clinical manifestations of childhood atypical EBTB were various.The major were cough(11 cases, 91.7%) and fever(7 cases, 58.3%), other manifestations included wheeze(3 cases, 25.0%), shortness of breath following exercise(2 cases, 16.7%), and so on.Only 1 case had hemoptysis (8.3%). The major imaging findings were lymph node enlargement of hilar and(or) mediastinum (10 cases, 83.3%). Five cases were with obstructive pulmonary emphysema and atelectasis (41.7%). It was more common than other type of pulmonary tuberculosis.It mainly expressed granulation tissue and neoplasm(7 cases, 58.3%), caseoussubstance(4 cases, 33.3%), extrinsic compression(4 cases, 33.3%) and narrowed orifice of the lobe bronchus(2 cases, 16.7%)under fiber bronchoscopy.The detection rate of mycobacterium tuberculosis was 50.0%(6 cases) through bronchoalveolar lavage fluid.Four children were diagnosed by transbronchial biopsy and 2 children were diagnosed by gastrointestinal fluid smear after fiberoptic bronchoscopy. Conclusions The clinical manifestations of childhood atypical EBTB are various.Bronchoscopy examination, bronchoalveolar lavage and transbronchial biopsy play very important role in diagnosis and pathological classification of childhood atypical EBTB. Key words: Atypical endobronchial tuberculosis; Clinical manifestation; Bronchoscopy; Child