Fibrobroncoscopia en la tuberculosis endobronquial

Abstract

Endobronchial tuberculosis is a classical manifestation of primary tuberculosis in childhood. Fiberoptic bronchoscopy (FB) is an ancillary diagnostic tool, but its utility and indications are not well established. To analyze the FB performed over 11 years (1992-2003) in children with a diagnosis of tuberculosis and to review the literature. A further aim was to establish the current usefulness of FB in children with tuberculosis and propose criteria to determine the indications for FB in this population. We report a retrospective series (n 5 16). FB was indicated in children who showed any of the following findings in chest roentgenogram: a) persistent parenchymal consolidation; b) lymphadenopathy and consolidation; c) hyperinsufflation (emphysema); d) atelectasias, and e) airway narrowing caused by lymphadenopathies. Published series on the topic were reviewed and six studies were suitable for comparison with our own. Endobronchial tuberculosis was found in seven children (43 %) and extrinsic compression was found in three (18 %). The microbiological results obtained from FB samples were not superior to those obtained from classical diagnostic methods. The sensitivity of the proposed criteria for suspicion of endobronchial tuberculosis was 71 %. Endoscopic findings justified a change in therapy in 50 % of the children (addition of corticoids or surgery) and this percentage was similar to that reported in other series. FB does not usually improve microbiological diagnosis of tuberculosis but can be useful when choosing the most appropriate therapy in children with suspected endobronchial tuberculosis. In some cases, computed tomography may make FB unnecessary, but in others this procedure can be therapeutic (obstruction due to caseum, atelectasias). Establishing the indications for FB in childhood tuberculosis is difficult, but the proposed criteria may be an acceptable guide to identifying which patients could benefit most from this procedure. Not all children with endobronchial tuberculosis require corticoids.