Endobronchial tuberculosis presenting as right middle lobe syndrome: clinical characteristics and bronchoscopic findings in 22 cases.
OBJECTIVE
Endobronchial tuberculosis (EBTB) presenting as right middle lobe syndrome (RMLS) is an uncommon clinical condition. We investigated the clinical characteristics in patients with EBTB presenting as RMLS.


METHODS
We retrospectively reviewed the records of 22 patients with EBTB presenting as RMLS who were diagnosed at our hospital from 2003 to 2006.


RESULTS
Its occurrence was more common in females than males (F, 18; M, 4). The mean age was 70.3 +/- 8.5 years, and 17 patients were above the age of 65 years. Cough with sputum was the most common manifestation and 2 patients were asymptomatic. In bronchoscopic analysis, the most common finding was edematous-type EBTB, which was found in 15 patients, followed by actively caseating type in 6 and tumorous type in 1. Acid-fast bacilli (AFB) staining for bronchial washing fluid was positive in only 5 patients: 1 with edematous type and 4 with actively caseating type. Bronchoscopic biopsy showed chronic granulomatous inflammation in 16 patients. Follow-up chest X-ray after treatment showed complete disappearance of the lesion in 2 patients, more than 50% improvement in 5, less than 50% improvement in 5, and no change of lesion in 4.


CONCLUSIONS
Edematous-type EBTB was the most common type of EBTB presenting as RMLS, and it usually occurred in elderly patients. Culturing for mycobacterium and histologic examination by bronchoscopy are necessary for proper diagnosis in these patients.
Kim
Ho Cheol
HC
Department of Internal Medicine, College of Medicine, Gyeongsang National University, 92 Chilam-dong, Jinju 660-751, Korea. hochkim@gshp.gsnu.ac.kr
Kim
Hyeon Sik
HS
Lee
Seung Jun
SJ
Jeong
Yi Yeong
YY
Jeon
Kyoung-Nyeo
KN
Lee
Jong Deok
JD
Hwang
Young Sil
YS
D000368:Aged; D000369:Aged, 80 and over; D001982:Bronchial Diseases / Q000000981:diagnostic imaging* / Q000473:pathology*; D001999:Bronchoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008878:Middle Lobe Syndrome / Q000000981:diagnostic imaging* / Q000473:pathology*; D011859:Radiography; D014376:Tuberculosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology*