Tuberculous bronchonodal fistula in adult patients: CT findings

To describe the computed tomography (CT) findings of bronchonodal fistulas occurring in seven adult patients with active pulmonary tuberculosis (TB).

Seven patients with confirmed tuberculous bronchonodal fistula who underwent chest CT scans were enrolled. The patient demographics and CT and bronchoscopic findings were analyzed. The bronchonodal fistula site, distribution and characteristics of the involved lymph nodes, airway change, and parenchymal lesions found on CT were reviewed.

The seven patients comprised four males and three females. All patients were over 70 years old (range 72-85 years; mean age 78 years). The site of occurrence of the bronchonodal fistula was on the right side between the lobar bronchi and paratracheal or hilar lymph nodes in five patients and on the left side between the left main bronchus and subcarinal lymph nodes in two patients. The involved lymph nodes were necrotic in four patients and necrotic with partial calcification in three. In all patients, active pulmonary TB lesions involving multiple lobes were found as consolidations (n = 3), poorly defined nodules (n = 4), cavities (n = 1), or centrilobular nodules exhibiting tree-in-bud appearance (n = 7).

Bronchonodal fistula can occur as a complication of active pulmonary TB with TB lymphadenitis in adult patients, especially in the elderly. The fistulas usually involved the right side. The lobar bronchus was frequently involved on the right side and the main bronchus on the left side.