Bronchial obstruction and bronchiectasis complicating primary tuberculous infection

Abstract

Summary 1. Thirty-five patients with evidenceof bronchial obstruction secondary to primary tuberculous infection were studied. 2. Twenty-nine patients were bronchoscoped;of these a. Eleven had evidence of partial or complete bronchial occlusion which in one instance appeared due to extrinsic pressure alone and in ten instances was due to endobronchial disease or a combination of endobronchial disease and extrinsic pressure, b. Five (all with active tuberculous lesions of only a few months' duration) had evidence of acute infection nonspecific in type, c. Eleven had evidence of chronicsecondary pyogenic infection, d. Three had no evidence of endobronchialdisease. 3. Twenty-eight patients had bronchographicstudies done, and of these, twenty were found to have bronchiectasis. This was of the saccular (cystic) variety in ten patients and tubular in ten. The bronchiectatic changes were found equally distributed between all the pulmonary lobes but showed preponderance in the anterolateral (pectoral) segment of the upper lobes, the apical segment of the lower lobes, and the right middle lobe. This is believed to be related to the distribution of the lymphatic nodes in these areas. 4. The autopsy protocols of 186children dying of tuberculosis were reviewed. Fifteen children were found to have bronchiectasis as a complication of primary tuberculous infection. 5. Bronchoscopic examination is importantwhen there is clinical evidence of bronchial obstruction or roentgenological evidence of pulmonary involvement in a tuberculous process of greater extent than a simple primary focus as bronchoscopic relief of the obstruction may be possible. 6. Abnormal physical signs and symptoms, and roentgen-ray findings occurring after the primary tuberculous infection has had reasonable time to subside may result from superimposed bronchiectasis. This can only be satisfactorily investigated by bronchography. Surgical therapy may be necessary in some patients to control symptoms of secondary pyogenic infection.