Letters to the Editor

Indian Pediatrics 2002; 39:977

Endobronchial Tuberculosis and the Surgeon

Endobronchial tuberculosis (ETB) occurs commonly as a complication of primary pulmonary tuberculosis in children and usually presents to the physician. We present our experience with this child who had endobronchial tuberculosis (ETB) and was referred with a suspicion of foreign body in bronchus.

A two year old male orphan child was referred with a suspicion of foreign-body inhalation. He had history of fever and cough of one month duration. Reliable past history was not available as the natural parents were unknown. At presentation, the child was active and afebrile. Air entry was bilaterally equal and rhonchi were heard on the left side. His hemogram was normal; HIV serology was negative and the tuberculin sensitivity test was positive (11 mm). Roentgenogram of the chest showed over-inflation of the left lung with shift of trachea to the right. CT examination of the chest showed hyper-inflation of left lung and focal narrowing of the left main bronchus with no detectable focal lesion or lymphadenopathy. Rigid bronchoscopic examination was done under anesthesia which showed a whitish, polypoidal mass-lesion (1 cm in diameter) arising from the left main bronchus occupying 3-6º clock position. Biopsy from the lesion confirmed tuberculosis on histopathologic examination. Child was started on anti tubercular therapy along with prednisone (1 mg/kg) and is well at 3 months followup.

Survey of the literature shows that obstructive emphysema in children less than 3 years of age is usually due to foreign body inhalation(1). ETB presents with persistent atelectasis, radiological patch or bronchi-ectasis in an older child(2,3). ETB presenting as intrinsic bronchial mass without hilar or mediastinal lymphadenopathy gives rise to diagnostic difficulties. Primary bronchial tumors in children, though rare, constitute the differential diagnosis. Clinicians need to be aware of ETB presenting as luminal mass because this could be confused with foreign body aspriation or a tumor.

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References

1. Puhakka H, Kero P, Valli P, Iisalo E, Erkinguntti M. Pediatric bronchoscopy. A report of methodology and results. Clin Pediatr 1989, 28: 253-257.

2. Joshi S, Malik S, Kandoth PW. Diagnostic and therapeutic evaluation of bronchoscopy. Indian Pediatr 1995; 62: 83-87.

3. Wood RH, Postma D. Endoscopy of the airway in infants and children. J Pediatr 1988; 112: 1-6.