The Usefulness of Bronchoscopy for the Diagnosis of Pulmonary Tuberculosis

Abstract

Objectives To demonstrate the usefulness of bronchoscopy compared with expectorated sputum for the diagnosis of pulmonary tuberculosis (TB) in a tertiary hospital. Methods We retrospectively evaluated the clinical characteristics of patients diagnosed with pulmonary TB by bronchoscopy because of negative sputum smears for acid-fast bacilli and then compared them with those of patients diagnosed with pulmonary TB from expectorated sputum between 2001 and 2005 in Kawasaki Medical School Hospital. Results Bronchoscopy with bronchoalveolar lavage fluid, bronchial brushing, or transbronchial lung biopsy was performed in 16 cases suspected of pulmonary TB. The diagnostic yield of pulmonary TB was best from bronchoalveolar lavage fluid specimens (93%), compared with that from other bronchoscopic specimens. The clinical characteristics of patients diagnosed by bronchoscopy compared with patients diagnosed from sputum were as follows: the percentage of males was significantly lower, many were bedridden patients, many patients were detected during the health examinations without clinical symptoms, and many patients had atypical radiologic findings such as lower lung field TB or pulmonary tuberculoma. The duration from admission to diagnosis was significantly shorter in patients diagnosed by bronchoscopy than those diagnosed from expectorated sputum. There were no complications due to bronchoscopy in 16 cases. Conclusions We think that it is better to perform a bronchoscopy on patients suspected of possible pulmonary TB to obtain a correct diagnosis and to prevent nosocomial infection. This is useful because most of the patients' bedridden due to other underlying diseases could not expectorate appropriate sputum for examination and many patients with severe underlying diseases had atypical clinical characteristics.