[New classification of endobronchial tuberculosis and balloon dilatation of bronchial stenosis]

Endobronchial tuberculosis frequently leaves bronchial stenosis as the complication despite of modern efficacious chemotherapy, and it may be misdiagnosed as bronchial asthma or bronchogenic carcinoma. When bronchial stenosis involves major airway, its treatment needs such special measures as steroid therapy, surgical intervention and/or laser therapy, but the therapeutic result is often disappointing. We have introduced a new classification of endobronchial tuberculosis, analyzing bronchoscopic findings in 166 cases of endobronchial tuberculoses. Namely, endobronchial tuberculosis was classified into seven subtypes as stenotic type with fibrosis, stenotic type without fibrosis, actively caseating type, tumorous type, ulcerative type, granular type, and nonspecific bronchitic type. Actively caseating type (48 cases: 28.9%), stenotic type without fibrosis (44 cases: 26.5%), nonspecific bronchitic type (31 cases: 18.7%) and stenotic type with fibrosis (30 cases: 18.1%) were predominant in the order of frequency, but tumorous type (9 cases: 5.4%), ulcerative type (2 cases: 1.2%) and granular type (2 cases: 1.2%) were relatively uncommon. Stenotic type with or without fibrosis, actively caseating type and tumorous type of endobronchial tuberculosis were closely related to bronchial stenosis. In these cases, it is necessary to apply specific measures for preventing or minimizing bronchial stenosis. To consider the therapeutic effect of steroid on the alleviation of bronchial stenosis in endobronchial tuberculosis, it may be very effective when the interval between symptom-onset and treatment with steroid is less than 6 months. To exploit a new treatment modality for bronchial stenosis, balloon dilatation was also carried out in 12 patients with endobronchial tuberculosis. Under local anesthesia, 4F-Fogarty balloon was inserted via bronchofiberscope in ten cases and 10F-Gruentzig balloon was introduced under fluoroscopic guide in two others.(ABSTRACT TRUNCATED AT 250 WORDS)