結核性気管狭窄

Abstract

Tracheal stenosis due to tuberculosis is not so common. Among 111 cases of bronchial tuberculosis which were diagnosed bronchoscopically during the period from 1975 to 1986, 19 cases were combined with tracheal tuberculosis. Out of these 19 cases of tracheal tuberculosis, 18 cases were related to the tuberculous lesion of the main bronchus. This fact suggests that tracheal tuberculosis has a strong correlation with bronchial tuberculosis. Types of the tracheal lesions were classified as intramucosal tubercles in 9 cases, granulation in 8, and scar with stenosis in 2. Only one, however, had clinically significant stenosis of the trachea in this series. Another case of clinically significant tracheal stenosis due to tuberculosis was found after this series. The clinical features of these two cases were demonstrated. Case 1 was 45 year-old female patient. She complained of hoarseness and shortness of breath. Sputum was positive for tubercle bacilli. Bronchofiberscopy revealed marked stenosis of the trachea and the left main bronchus. The trachea also showed a sign of tracheomalacia. After failing in a primary operation for tracheomalacia, a T-tube stent was introduced into the trachea by tracheostomy, which has reduced the complains and improved the pulmonary function. Case 2 was 62 year-old male patient. He complained of shortness of breath. Bronchofiberscopy revealed localized stenosis of the trachea with granulation and scar, which showed a sign of malacia. His right lung was destroyed completely and tubercle bacilli were found in sputum. Right pneumonectomy was performed, combined with partial resection and anastomosis of the trachea. Histological examination of the resected trachea revealed tuberculous granulation in the mucosa and destruction of the tracheal cartilage, which caused malacia. Post-operative course was uneventful.