Presentation
Pulmonary tuberculosis was diagnosed on sputum testing. On treatment for 3 months. Presenting with dyspnea and chest discomfort for a few days. The patient was tachycardic, tachypneic, and hypoxic.
Patient Data
Narrowed tracheal and bronchial lucencies.
Clear lung fields, no pleural effusion.
No hilar adenopathy.
The cardiothoracic ratio is normal.
Normal bones and soft tissues.
Tracheal and left bronchial stenosis due to circumferential thickening measuring 5 mm and 2.9 mm respectively.
Left apicoposterior perilymphatic lymph node.
Left apicoposterior and lingular fibrosis, tree in bud nodularity and ground glass opacification.
No evidence of pulmonary emboli or other causes of dyspnea.
Case Discussion
Airway involvement of tuberculosis is manifested as tracheal or bronchial stenosis. Chest X-ray features are indirect signs of stenosis including lobar atelectasis or mucoid impaction 1.
CT may demonstrate wall thickening, complete obstruction, or obstruction due to adjacent adenopathy. CT may differentiate from endobronchial carcinoma by demonstration of long segment narrowing without internal mass 2.
Bronchial stenosis is seen in 10-40% of patients with active TB 3.
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