Endobronchial tuberculosis in paediatric population – a bronchoscopy tale of 15 years

C. Da Silva Alves*^a (Dr), M. Alves^b (Dr), L. Maia Morais^c (Dr), M. Ferrão Silveira^a (Dr), L. Santos^a (Dr), R. Costa^a (Dr), J. Boléo-Tomé^a (Dr)

^a Pulmonology Department, Hospital Professor Doutor Fernando da Fonseca, Amadora, PORTUGAL ; ^b Pulmonology Department, Centro Hospitalar Lisboa Ocidental, Lisboa, PORTUGAL ; ^c Intensive Care Unit, Centro Hospitalar Lisboa Ocidental, Lisboa, PORTUGAL

* cmdsalves@gmail.com

Backgound: Pulmonary Tuberculosis (TB) in the paediatric population is characterized by enlarged mediastinal lymph nodes which compress and infiltrate the airways resulting in endobronchial tuberculosis (EBTB). There is still modest data regarding children EBTB.

Methods: Medical records of patients under 18 years with a suspected or confirmed Mycobacteria tuberculosis lung infection, between January 2006 to May of 2022, were retrospectively reviewed. Bronchoscopy findings were classified according to Chung classification for tuberculous lesions in adults (actively caseating, fibrostenotic, edematous-hyperemic, tumorous, ulcerative, granular, and nonspecific bronchitic).

Results: Seventy-three bronchoscopy exams performed due to pulmonary TB were reviewed, and 34 (47%) with EBTB were included in the study. This included 27 (79%) flexible bronchoscopies and 7 (21%) rigid bronchoscopies. Suspected tuberculosis (65%, n=22) was the main indication for bronchoscopy, followed by unfavorable clinical/radiologic progression (35%, n=12). Median age at diagnosis was 7 (IQR 3.8-14.2) and patients were predominanly male (59%, n=20). Bronchoscopy findings were: mucosal edematous-hyperemic (65%, n=22), granular (35%, n=12), fibrostenosis (12%, n=4), tumorous (3%, n=1) and ulcerative (3%, n=1). Extrinsic compression was found in 24% (n=8) of the exams; 2 cases had significant bronchial stenosis and underwent balloon dilatation with lumen restoration. Six (18%) patients had endobronchial granulomas. From these, 3 had significant stenosis and were removed through laser photocoagulation followed by balloon dilatation with good results.

Conclusion: EBTB was present in almost half of the bronchoscopies for TB investigation, being edematous-hyperemic mucosa the most common manifestation. Bronchial and segmental stenosis was a common complication of EBTB and effective lumen restoration was possible with balloon dilatation. The variability of bronchoscopic findings urges for a valid classification for the pediatric population.

Disclosure of funding source(s): none