| Balloon dilatation of bronchial stenosis in endobronchial tuberculo- sis. |
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Hee Soon Chung1, Sung Koo Han2, Young Soo Shim2, Keun Youl Kim2, Yong Chol Han2, Woo Sung Kim3, Jung Gi Im4 |
1Department of Internal Medicine, Seoul National University College of Medicine and Youngdeungpo Municipal Hospital, Seoul, Korea
2Department of Internal Medicine and Tuberculosis Research Institute, Seoul National University College of Medicine, Seoul, Korea
3Department of Internal Medicine, College of Medicine, Ulsan University, Seoul, Korea
4Department of Radiology, Seoul National University College of Medicine, Seoul, Korea |
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| Abstract |
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The prevalence rate of pulmonary tuberculosis is 1 .8% in 1990, and endobronchial tuberculosis may exist in 10 to 40 % of active diseases. Endobronchial tuberculosis usually leaves bronchial stenosis as the complication despite of modern chemotherapy, and it is often misdiagnosed as bronchial asthma When bronchial stenosis involves major airway, its treatment needs such special measures as steroid therapy, surgical interventi on and/ or laser therapy, but the therapeutic result is often disappointing To exploit a new treatment modality for bronchial stenosis, balloon dilatation wa s carri ed 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.
Endobronchial tuberculosis were subdivided into two(16. 7%) with actively caseating type, seven (58.3%) with fibrostenotic type, and three (25 .0%) with stenotic type without fibrosis, according to the bronchoscopic findings. In 7 healed cases which were all stenotic with fibrosis, three (42 .9%) took favorable tum in clinical status but four (57.1%) were not improved with balloon dilatation. In 5 active cases, all (two with actively-caseating type and three with stenotic type without fibrosis) were improved with this method. FEV 1.0 or FVC increased 10% or more after procedure in seven (70.0%) of ten and bronchial lumen remained enlarged in eight (66.7%) of twelve, in whom follow-up examination was done after the procedure.
Balloon dilatation of bronchial stenosis is more effective. when endobronchial tuberculosis is in active stage than in healed fibrotic stage. It is suggested that bronchial stenosis can be minimized by early diagnosis and early application of balloon dilatation in the course of disease. |
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