Bronchoscopy Balloon Dilation in Endobronchial Tuberculosis with Airway Stenosis: A Case Series
IA. Pratiwi*a (Mrs), M. Elhidsia (Dr), D. Soehardimana (Dr), P. Prasenohadib (Dr)
a Pulmonology and Respiratory Medicine, Faculty of Medicine Universitas Indonesia – Persahabatan Hospital, East Jakarta, INDONESIA ; b Pulmonology and Respiratory Medicine, Faculty of Medicine Universitas Indonesia – Persahabatan Hospital, East Java, INDONESIA
Introduction: Endobronchial tuberculosis (EBTB) is an extra pulmonary tuberculosis form which defined as tuberculosis infection of the tracheobronchial tree with microbial and histopathological evidence. The most common complication of EBTB is airway stenosis. We report two cases of the role of bronchoscopy balloon dilation in EBTB.
Case Report: Case 1: A 31 years old woman with stridor, dyspnea, cough and weight loss. CT scan finding showed atelectasis in right superior lobe. Xpert MTB/RIF from sputum sample was negative. Histopathological finding from bronchus biopsy showed chronic granulomatous inflammation caused by MTB. Bronchoscopy finding showed cicatrix closing almost total mid trachea and total right main bronchus, right upper lobe and truncus intermedius. Balloon dilation and steroid injection were performed three times. Anti TB regiment with RHZE/RH was administered. She is now on fourth months of anti-TB drug. She experienced recurrent stridor and dyspnea one month after second balloon dilation and had to do emergency third balloon dilation, steroid injection and rigid scope dilation. She had complication of tracheal laceration in third ballooning. Case 2: A 17 years old girl with dyspnea, productive cough and mild fever. Xpert MTB/RIF from bronchial washing sample was MTB positive with Rifampicin sensitive. CT scan finding showed atelectasis in right lung. Bronchoscopy finding showed cicatrix closing almost total right main bronchus. Balloon dilation were performed twice. She is now on eight months of anti TB drugs. Immediate symptoms improvement was experienced in both cases.
Conclusion: Bronchoscopy balloon dilation and anti TB drugs were main therapy in EBTB and airway stenosis. Bronchoscopy balloon dilation gave immediate symptoms relieve. Recurrent procedure might be performed to optimize the treatment.
Disclosure of funding source(s): none