Abstract
Bronchial dilatation is a potentially serious and irreversible clinical and radiological entity. It is an often underdiagnosed condition, particularly in developing countries. This clinical image presents bronchial dilatations of casual discovery associated with radiographic images suggestive of progressive pulmonary tuberculosis. Thoracic imaging remains crucial in the diagnosis of bronchopulmonary diseases.
Keywords: bronchiectasis, developing countries, diagnosis, imaging, pulmonary tuberculosis
1. CASE PRESENTATION
A 24‐year‐old man, ex‐smoker at 5 pack‐years, consulted for cough and shortness of breath. He had no specific past medical history. His illness began 3 years earlier by wet cough producing whitish sputum, sometimes abundant, evolving in a context of impaired general condition with asthenia, anorexia, weight loss of 10 kg, and intermittent fever. He would have received amoxicillin 2–3 g/day from time to time, but the disease persisted. He had no previous investigations. On admission, chest radiography revealed bilateral, diffuse, and polymorphic lung lesions (Figure 1).
FIGURE 1.
Chest radiography showing, in the left lung, a large apical thick‐walled excavation (white arrow) associated with a heterogeneous retractile opacity occupying the rest of the lung area and containing images of bronchial clarity (black arrow), with increased caliber, roughly rounded shape, and thick wall.
2. WHAT IS YOUR DIAGNOSIS?
It was a progressive pulmonary tuberculosis associated with bronchial dilatations.
Sputum examination for acid‐fast bacilli was positive. In addition, bacteriological examination of the sputum revealed a bacterial superinfection with Staphylococcus sp. Human immunodeficiency virus serology was negative. Chest CT scan showed in the upper lobe of the left lung: a large thick‐walled excavation suggestive of tuberculosis cavity, associated with diffuse bronchial dilatations in varicose and sometimes cystic forms (Figure 2A). On the right, a localized cylindrical bronchial dilatation was associated with micronodular opacities, giving the typical budded tree appearance of pulmonary tuberculosis (Figure 2B).
FIGURE 2.
(A) Chest CT scan in coronal view on parenchymal window showing bronchial dilatations in varicose form (orange circle) and cystic (orange arrow) associated with the large excavation (black arrow) in the left lung. (B) Chest CT scan in coronal view on parenchymal window revealing localized cylindrical bronchial dilatation (yellow arrow) associated with micronodular opacities with a tendency to coalescence (yellow circle) in the right lung.
3. DISCUSSION
We reported a clinical image of progressive or active pulmonary tuberculosis with undiagnosed pre‐existing bronchial dilatation.
In case of suspicion of pulmonary tuberculosis, chest radiography remains the first‐lineexamination to realize. Active tuberculosis may manifest with cavities, consolidations, and centrilobular nodules. The definitive diagnosis is biological. 1
Bronchial dilatation or bronchiectasis is suspected in the presence of classic symptoms such as chronic cough, excessive sputum production, and recurrent respiratory infections. Chest CT scan confirms the presence of dilated airways. 2 There are many causes, mainly postinfective tuberculosis in highly endemic countries. However, bronchial dilatation may be congenital, as in our case. In any case, bronchial dilatation worsens the prognosis of the patient who will be exposed to frequent and sometimes disabling exacerbations. Management is essentially based on smoking cessation, preventive and/or curative treatment of bacterial superinfections, and more rarely on surgical removal. 2
AUTHOR CONTRIBUTIONS
Zamelina Angela Razafindrasoa: Conceptualization; writing – original draft; writing – review and editing. Kiady Ravahatra: Conceptualization; formal analysis. Sonia Marcelle Razafimpihanina: Conceptualization. Fidy Arnauld Martin: Conceptualization. Diamondra ombanjanahary Andriarimanga: Supervision. Davis Avazara Randrianasolo: Supervision. Jocelyn Robert Rakotomizao: Validation. Harison Michel Tiaray: Validation. Joëlson Lovaniaina Rakotoson: Validation. Rondro Nirina Raharimanana: Formal analysis; validation.
FUNDING INFORMATION
No source of funding.
CONFLICT OF INTEREST
The authors declare no conflict of interest.
CONSENT
A written informed consent was obtained from the patient to allow us to publish a report of his case for educational purposes.
ACKNOWLEDGMENT
We would like to thank the Pulmonology team, especially at Fenoarivo University Hospital for the care of this particular patient.
Razafindrasoa ZA, Ravahatra K, Razafimpihanina SM, et al. Progressive pulmonary tuberculosis associated with bronchial dilatation: A clinical image. Clin Case Rep. 2022;10:e06704. doi: 10.1002/ccr3.6704
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are not publicly available due to privacy restrictions. The data are available on reasonable request from the corresponding author.
REFERENCES
- 1. Nachiappan AC, Rahbar K, Shi X, et al. Pulmonary tuberculosis: role of radiology in diagnosis and management. Radiographics. 2017;37(1):52‐72. doi: 10.1148/rg.2017160032 [DOI] [PubMed] [Google Scholar]
- 2. Macfarlane L, Kumar K, Scoones T, Jones A, Loebinger MR, Lord R. Diagnosis and management of non‐cystic fibrosis bronchiectasis. Clin Med (Lond). 2021;21(6):e571‐e577. doi: 10.7861/clinmed.2021-0651 [DOI] [PMC free article] [PubMed] [Google Scholar]
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 not publicly available due to privacy restrictions. The data are available on reasonable request from the corresponding author.