Bronchial Tuberculosis and Mucoid Impaction

Pathology and Pathogenesis

Airway tuberculosis in its proximal form may mimic a neoplasm and is noteworthy for extensive necrosis and often large numbers of bacilli. The characteristic granulomatous morphology may not be visible around the necrotic material. The distal airway involved with mucoid impaction is dilated, and its wall shows nonspeciÞc chronic inßammatory changes varying from a mild inÞltrate to a severe reaction that includes many eosinophils. The affected airway may be merely distended and therefore returns to normal after the plug is expectorated, or its wall may be largely destroyed by the inßammation.

Symptoms and Signs

Clinical manifestations of bronchial tuberculosis may be acute, insidious, or delayed. It is frequently misdiagnosed as bronchial asthma. Common symptoms include cough, shortness of breath, wheezing and fever, and hemoptysis [15]. On chest auscultation, diminished breath sound, rhonchus, and Þxed wheezing can be heard.

can be relieved by bronchoscopic intervention therapy (balloon dilation, laser therapy, or stent insertion) or reconstructional bronchial surgery.

Foreign-Body Aspiration

Pathology and Pathogenesis

The inhalation of a foreign body is especially common in children, while the narrow, pliable bronchi of infants are particularly liable to be compressed by distended pulmonary arteries at points where they are in close anatomic proximity.

Symptoms and Signs

Symptoms of foreign-body aspiration can vary from lifethreatening airway obstruction or death to nonspeciÞc symptoms. Sudden onset of choking sensation and intractable cough is the most common. Other symptoms include cough, fever, breathlessness, and wheezing [16]. Older patients are more likely to be mistakenly diagnosed as chronic obstructive pulmonary disease or pneumonia.

The principal CT Þndings of bronchial tuberculosis are circumferential wall thickening and luminal narrowing, with the involvement of a long segment of the bronchi. However, aneurysmal appearance of medium-sized bronchi with abrupt ending of the air column and without narrowing of proximal airway is another CT feature of bronchial tuberculosis (Fig. 10.3) [6].

Although foreign bodies may become lodged in any location of the tracheobronchial tree, the most common sites are the right lower lobe, intermediate bronchus, and left main bronchus [17]. Chest CT images often show the intrabronchial foreign body and associated features such as atelectasis, hyperlucency, bronchiectasis, lobar consolidation, mucoid impaction with gloved Þnger sign, a tree-in-bud pattern, and a thickened bronchial wall adjacent to the foreign body [18].

CT–Pathology Comparisons

Aneurysmal appearances of the medium-sized bronchi represent large caseating granulomas Þlling the lumen of the medium-sized bronchi [6].

Patient Prognosis

The eradication of Mycobacterium tuberculosis and the prevention of bronchial stenosis are the main goals for the treatment of bronchial tuberculosis. Delayed diagnosis results in the permanent Þbrotic stricture of the involved bronchial trees. Standard treatment with antituberculosis drugs should be given promptly once it is diagnosed. Symptomatic bronchial stenosis even after the antituberculosis chemotherapy

CT–Pathology Comparisons

CT Þndings of bronchiectasis and mucoid impaction with gloved Þnger sign and air trapping with a resultant decrease in perfusion of the compromised segment or lobe result from the remnants of aspirated foreign bodies for long periods of time [17].

Patient Prognosis

After initial airway support, prompt removal of foreign body is necessary to avoid complications. Both rigid and ßexible bronchoscopies can be utilized to remove the foreign bodies in the airway.