Abstract
Large amount of caseating overlying on bronchus were detected under bronchoscopy in our case. Bronchoalveolar lavage is a major method for diagnosing tuberculosis (TB). TB dissemination caused by bronchoalveolar lavage is very rare. In this case, the patient developed fever after bronchoalveolar lavage and CT confirmed acute dissemination. This might be related to caseating EBTB.
Keywords: alveolar lavage, caseous necrosis, dissemination, tuberculosis
Bronchoalveolar lavage is a major method diagnosing tuberculosis (TB). TB dissemination caused by bronchoalveolar lavage is very rare. In this case, the patient developed fever after bronchoalveolar lavage and CT confirmed acute dissemination. This might be related to caseating EBTB.
CLINICAL IMAGE
A 38 year old woman, presented with cough and expectoration for 1 month. Computed tomography (CT) showed stenosis of left main bronchus and left upper lobe bronchus, scattered patchy and nodular shadows in left upper lobe and left lower lobe (Figure 1). Fiberoptic bronchoscopy showed that large amount of white moss covered the left main bronchus and left upper lobe bronchus, and the left lingular bronchus was obstructed (Figure 2A–D). We perform a biopsy on the mucosa of left upper lobe bronchus. Pathology indicated caseous necrosis and acid‐fast bacilli were observed (Figure 2E–G). Then, the bronchoalveolar lavage fluids (BALFs) from left upper lobe apicoposterior segment (B1/2) were collected and we found that tuberculosis DNA was positive in BALFs. However, the patient developed persistent fever after bronchoscopy examination and maximum body temperature was 41.0°C. CT of the thorax showed large area of consolidation and patchy shadows in the upper and lower dorsal segments of the left lung (Figure 3). We considered the occurrence of acute dissemination of tuberculosis.
FIGURE 1.
Computed tomography of the thorax. (A–D) Obvious stenosis (black arrow) of left main bronchus and left upper lobe bronchus, scattered patchy and nodular shadows in the left upper lobe and left lower lobe‐superior segment.
FIGURE 2.
Image under bronchoscopy and Pathology. (A–B) left main bronchus covered by white moss; (C) left upper lobe bronchus covered by white moss; (D) left upper lobe‐apicoposterior and anterior segment was normal; left lingular bronchus was obstructed; (E–F) caseous necrosis (Haematoxylin and eosin staining; E: ×100; F: ×200); (G) acid‐fast bacilli (black arrows) (Ziehl‐Neelsen staining; G: ×400).
FIGURE 3.
Computed tomography of the thorax after bronchoalveolar lavage. (A–D) Large area of consolidation and patchy shadows in the upper and lower dorsal segments of the left lung.
Endobronchial tuberculosis (EBTB) is defined as a tuberculous infection of the tracheobronchial tree with microbial and histopathological evidence. 1
Bronchoalveolar lavage (BAL) is a major method to diagnose pulmonary tuberculosis (TB). 2 , 3 In this case, the patient developed persistent fever after bronchoalveolar lavage and CT findings confirmed the presence of acute dissemination. This might be related to active caseating EBTB.
AUTHOR CONTRIBUTIONS
Yunjie Cui and Cuiping Yang were the lead author involved in drafting the initial manuscript and preparing the images. Cuiping Yang and Bo Wang provided radiological expertise including interpretation and description of the images. All authors contributed to the writing, review and final approval of the manuscript.
FUNDING INFORMATION
The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not‐for‐profit sectors.
CONFLICT OF INTEREST STATEMENT
None declared.
ETHICS STATEMENT
Patient consent for publication has been obtained prior to submission. Participants gave informed consent to participate in the study before taking part.
Cui Y, Wang B, Yang C. Imaging of acute dissemination of tuberculosis caused by alveolar lavage surgery in endobronchial tuberculosis characterized by caseous necrosis. Respirology Case Reports. 2024;12(11):e70059. 10.1002/rcr2.70059
Yunjie Cui and Bo Wang have contributed to the article equally.
Associate Editor: Francesca Gonnelli
Contributor Information
Yunjie Cui, Email: 1450153356@qq.com.
Cuiping Yang, Email: yangcuiping12@163.com.
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available on request from the corresponding author.
REFERENCES
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author.