Ersin Şükrü ERDEN, Cenk BABAYİĞİT, Mesut DEMİRKÖSE, Hatice BİLGİÇ, Mehmet YALDIZ, Melek İNCİ, Sinem KARAZİNCİR

SANTRAL BRONŞ TÜMÖRÜNÜ TAKLİT EDEN ENDOBRONŞİYAL TÜBERKÜLOZ OLGUSU

Endobronşiyal tüberküloz (EBTB), trakeobronşiyal ağacın mikrobiyolojik ve histopatolojik bulgularla kanıtlanmış tüberküloz infeksiyonu olarak tanımlanmaktadır ve akciğer tüberkülozunun ciddi komplikasyonlarından biridir. EBTB'lu olgular sıklıkla bronşiyal astım ya da akciğer kanseri gibi yanlış tanılar alabilmektedir. Elli yaşında bayan hasta pnömoni tanısı ile on günlük ampirik antibiyotik tedavisi ile kliniğinde herhangi bir düzelme olmaması üzerine çekilen Toraks BT'de sağ hiler bölgede kitle tespit edilmesi üzerine hastanemize sevk edildi. Hastaya yapılan bronkoskopide sağ akciğer üst lob girişinde mukozal infiltrasyon ve segment ayrımından önce endobronşiyal tümöral lezyon izlendi, buradan forceps biyopsi ve lavaj yapıldı. Lavaj sıvısında ARB (++) bulundu, biyopsi sonucu kazeifikasyon içeren granülomatöz proçes olarak değerlendirildi. Hastaya altı aylık standart anti-tüberküloz tedavi verildi. Tedavinin altıncı ayı sonunda çekilen Toraks BT'de sağ hiler bölgede izlenen kitle görünümünün tamamen kaybolduğu görüldü. Sonuç olarak burada, santral bronş tümörünü taklit eden ve anti-tüberküloz tedavi ile başarı ile tedavi edilen EBTB olgusu sunulmaktadır. Bu olgulara bronkoskopi ve bronkoskopik materyalde tüberküloz tanısına yönelik incelemelerin yapılması hem doğru tanının konulması hem de tedavinin erken başlanarak bronkostenoz gelişminin önlenmesi bakımından büyük önem taşımaktadır.

Anahtar Kelimeler:

Akciğer kanseri, Bilgisayarlı Tomografi, Bronkoskopi, Tüberküloz

A CASE: ENDOBRONCHIAL TUBERCULOSIS MIMICING CENTRAL BRONCHIAL TUMOR

Endobronchial tuberculosis (EBTB) is defined as tuberculosis infection of the tracheobronchial tree proven by microbiologically and histopathologically findings and is one of the serious complications of pulmonary tuberculosis. Often, patients may be misdiagnosed such as bronchial asthma or lung cancer. A 50 year old female patient had 10 days of empirical antibiotic therapy with a diagnosis of pneumonia. She has been shipped to our clinic because of the lack of clinical improvement and right hilar mass on chest CT. In bronchoscopy, mucosal infiltration on the entrance of right upper lobe and the endobronchial tumoral lesion before segment junction were seen, biopsy and lavage were performed here. ARB had been found (+ +) in lavage fluid, biopsy was assessed as a granulomatous processes with caseation. The patient received six-month standard antituberculosis treatment. At the end of the sixth month of treatment the right hilar mass completely disappeared on chest CT. In conclusion, EBTB which was mimicing the central bronchial tumor, and successfully treated with anti-tuberculosis treatment is presented in this study. In these cases, bronchoscopy and bronchoscopic material examinations for tuberculosis has a great importance for correct diagnosis and to prevent the bronchial stenosis by early treatment.

Keywords:

Pulmonary Neoplasm, Computed Tomography, Broncoscopy, Tuberculosis,

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1. Mu D, Nan D, Li W, et al. Efficacy and safety of bronchoscopic cryotherapy for granular endobronchial tuberculosis. Respiration; international review of thoracic diseases. 2011;82(3):268-72.
2. Park MJ, Woo IS, Son JW, et al. Endobronchial tuberculosis with expectoration of tracheal cartilages. The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology. 2000; 15(4): 800-2.
3. Han JK, Im JG, Park JH, Han MC, Kim YW, Shim YS. Bronchial stenosis due to endobronchial tuberculosis: successful treatment with self-expanding metallic stent. AJR American journal of roentgenology. 1992;159(5):971-2.
4. Matthews JI, Matarese SL, Carpenter JL. Endobronchial tuberculosis simulating lung cancer. Chest. 1984;86(4):642-4.
5. Williams DJ, York EL, Nobert EJ, Sproule BJ. Endobronchial tuberculosis presenting as asthma. Chest. 1988;93(4):836-8.
6. Xue Q, Wang N, Xue X, Wang J. Endobronchial tuberculosis: an overview. Eur J Clin Microbiol Infect Dis. 2011;30(9):1039-44.
7. Qingliang X, Jianxin W. Investigation of endobronchial tuberculosis diagnoses in 22 cases. Eur J Med Res. 2010;15(7):309-13.
8. Lee JH, Park SS, Lee DH, Shin DH, Yang SC, Yoo BM. Endobronchial tuberculosis. Clinical and bronchoscopic features in 121 cases. Chest. 1992;102(4):990-4.
9. Kashyap S, Mohapatra PR, Saini V. Endobronchial tuberculosis. Indian J Chest Dis Allied Sci. 2003;45(4):247-56.
10. Lee TH, Sin Fai Lam KN. Endobronchial tuberculosis simulating bronchial asthma. Singapore Med J. 2004;45(8):390-2.
11. Rikimaru T. Therapeutic management of endobronchial tuberculosis. Expert Opin Pharmacother. 2004;5(7):1463-70.
12. Lee JH, Chung HS. Bronchoscopic, radiologic and pulmonary function evaluation of endobronchial tuberculosis. Respirology. 2000;5(4):411-7.
13. Cakir E, Uyan ZS, Oktem S, et al. Flexible bronchoscopy for diagnosis and follow up of childhood endobronchial tuberculosis. Pediatr Infect Dis J. 2008;27(9):783-7.
14. Chung HS, Lee JH. Bronchoscopic assessment of the evolution of endobronchial tuberculosis. Chest. 2000;117(2):385-92.
15. Rikimaru T. Endobronchial tuberculosis. Expert Rev Anti Infect Ther. 2004;2(2):245-51.