Chest

Chest

Volume 100, Issue 3, September 1991, Pages 688-692
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Clinical Investigations
The Value of Flexible Bronchoscopy in Childhood Pulmonary Tuberculosis

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The value of 121 flexible bronchoscopy (FB) procedures was evaluated in 54 children, aged three months to 14 years, suspected of having pulmonary tuberculosis. Specimens from FB were culture-positive for Mycobacterium tuberculosis in seven of the 13 bacteriologically confirmed cases. Bronchial abnormalities consistent with the diagnosis were found in 31 of 54 cases. Separate or coexistent findings at initial FB included airway compression (20 cases), granulation tissue (ten cases), and obstructive caseum (four cases). Chest roentgenograms underestimated bronchial involvement in 14 children. Further FB monitoring documented disease evolution. The FB was important in the management of patients, as it (1) guided the use of prednisone therapy, especially in the children with a chest roentgenogram not suggestive of bronchial involvement; (2) indicated a need for resection of granulation tissue by rigid bronchoscopy (three cases); and (3) guided the surgical decision (two children with persistent bronchial obstruction). Thus, FB is a safe and valuable procedure in the management of childhood pulmonary tuberculosis. (Chest 1991; 100:688-92)

Section snippets

MATERIALS AND METHODS

The clinical records were reviewed in 54 suspected cases of childhood tuberculosis in which FB was performed at the Hôpital des Enfants Malades, Paris, from January 1987 to December 1989. During the same period, 44 children with tuberculous infection without pulmonary disease were observed. Flexible bronchoscopy is routinely performed in our institution when there are abnormalities on chest roentgenograms (enlarged hilar, parahilar, and paratracheal lymph nodes; parenchymal consolidation; or

Features of Population

The sex distribution of the studied population was 30 female and 24 male subjects. The mean age at presentation was four years (range, three months to 14 years). Eighteen of the children were less than two years old. Twenty-four children (44 percent) were symptomatic, the most frequent symptom being cough. The proportion of symptomatic cases was identical in the group aged less than two years. Twenty-eight (52 percent) of the 54 patients had previously received BCG vaccination. A history of

DISCUSSION

The flexible bronchoscopic has proven to be a useful investigative tool in many pediatric respiratory diseases.12,13 Its use in children with suspected pulmonary tuberculosis has already been advocated.14,15 In adults, FB is especially used in sputum-negative pulmonary tuberculosis, in an attempt to isolate M tuberculosis;16, 17, 18, 19, 20 however, other authors have emphasized its use in the identification and survey of endobronchial tuberculosis.5,6,21 Both aspects were analyzed in our

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    Manuscript received September 27; revision accepted January 8.

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    Copyright © 1991 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.