Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences Interbronchial Fistula by Endobronchial Tuberculosis Seung Jun Lee1, Kwang Nam Jin2, Sung Soo Park3, Deog Kyeom Kim3, Hee Soon Chung3, and Eun Young Heo3 1
Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea; and Department of Radiology, and 3Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea 2
Figure 2. Fiber optic bronchoscopy showing fistula just below the carina and cheese-like necrotic materials from the fistula to the right main bronchus.
Figure 1. Coronal computed tomography chest demonstrating a path between right and left main bronchus.
An 80-year-old woman presented with a 1-year history of cough and sputum. Computed tomography showed a 2.5 cm–sized solid lesion with surrounding micronodules in the right lower lobe together with mucosal wall thickening and luminal irregularity in the carina and right main bronchus. In a coronal image of chest computed tomography, a fistula between the right and the left main bronchus was suspected (Figure 1, arrows). Fiber optic bronchoscopy (Figure 2, arrows) revealed cheese-like necrotic materials in the right main bronchus and an adjacent fistula. Figure 3 shows the fistula through a three-dimensional reconstructed computed tomography image. Acid-fast bacilli were detected on a microscopic examination of bronchial-washing fluid and Mycobacterium tuberculosis was isolated in the same specimen. Interbronchial fistula has been reported rarely in association with endobronchial tuberculosis (1) and is likely related to 3.2 cm–sized necrotic subcarinal tuberculous lymphadenitis. The patient’s cough and sputum were improved after 4 weeks of treatment with an antituberculosis chemotherapy.
Am J Respir Crit Care Med Vol 188, Iss. 10, pp e69–e70, Nov 15, 2013 Copyright ª 2013 by the American Thoracic Society DOI: 10.1164/rccm.201302-0227IM Internet address: www.atsjournals.org
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AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VOL 188
2013
Author disclosures are available with the text of this article at www.atsjournals.org.
Reference 1. Nemati A, Safavi E, GhasemiEsfe M, Anaraki MZ, Firoozbakhsh S, Khalilzadeh O, Anvari M. Fistula formation between the right and left main bronchus caused by endobronchial tuberculosis. Am J Med Sci 2012;343:330–331.
Figure 3. Reconstructed computed tomography showing a definite fistula.
Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea; and Department of Radiology, and 3Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea 2
Figure 2. Fiber optic bronchoscopy showing fistula just below the carina and cheese-like necrotic materials from the fistula to the right main bronchus.
Figure 1. Coronal computed tomography chest demonstrating a path between right and left main bronchus.
An 80-year-old woman presented with a 1-year history of cough and sputum. Computed tomography showed a 2.5 cm–sized solid lesion with surrounding micronodules in the right lower lobe together with mucosal wall thickening and luminal irregularity in the carina and right main bronchus. In a coronal image of chest computed tomography, a fistula between the right and the left main bronchus was suspected (Figure 1, arrows). Fiber optic bronchoscopy (Figure 2, arrows) revealed cheese-like necrotic materials in the right main bronchus and an adjacent fistula. Figure 3 shows the fistula through a three-dimensional reconstructed computed tomography image. Acid-fast bacilli were detected on a microscopic examination of bronchial-washing fluid and Mycobacterium tuberculosis was isolated in the same specimen. Interbronchial fistula has been reported rarely in association with endobronchial tuberculosis (1) and is likely related to 3.2 cm–sized necrotic subcarinal tuberculous lymphadenitis. The patient’s cough and sputum were improved after 4 weeks of treatment with an antituberculosis chemotherapy.
Am J Respir Crit Care Med Vol 188, Iss. 10, pp e69–e70, Nov 15, 2013 Copyright ª 2013 by the American Thoracic Society DOI: 10.1164/rccm.201302-0227IM Internet address: www.atsjournals.org
e70
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VOL 188
2013
Author disclosures are available with the text of this article at www.atsjournals.org.
Reference 1. Nemati A, Safavi E, GhasemiEsfe M, Anaraki MZ, Firoozbakhsh S, Khalilzadeh O, Anvari M. Fistula formation between the right and left main bronchus caused by endobronchial tuberculosis. Am J Med Sci 2012;343:330–331.
Figure 3. Reconstructed computed tomography showing a definite fistula.
