[Clinical investigation of pulmonary tuberculomas diagnosed by video-assisted thoracoscopic biopsy]

We investigated the clinical characteristics of pulmonary tuberculomas and discussed strategies for their diagnosis. We compared a group of patients with lesions that had been diagnosed by bronchoscopy (the BF group: 15 patients, 17 lesions) with a group whose lesions had been diagnosed by thoracoscopy (the VATS group: 19 patients, 20 lesions). The VATS group included patients with lesions that could not be diagnosed by bronchoscopy alone. The 2 groups did not differ significantly in terms of patient age, gender, lesion size, number of bronchoscopic examinations, or tuberculin test findings. In both groups, the lesions always existed just below the pleural surface and were mostly located in the upper lobes of the lungs. Lesion locations in the middle lobe and lingular segment were observed only in the BF group, whereas locations in the lower lobes were observed only in the VATS group. Tuberculomas in 2 BF group patients (11%) and 10 VATS group patients (50%) were diagnosed on the basis of histopathologic findings in the absence of bacteriological evidence. No postoperative complications were observed in the VATS group, and all patients in this group were discharged from the hospital within 1 week. No relapse of tuberculosis was observed in either group following anti-tuberculous therapy. Video-assisted thoracoscopic biopsy is a reliable and minimally invasive diagnostic procedure, and should be performed on any solitary pulmonary lesion that cannot be diagnosed by bronchoscopy. It is important that tuberculomas be quickly and accurately diagnosed not only in order to distinguish them from lung cancer, but also to treat the patient's tuberculosis at an early stage and prevent it from spreading.