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Tuberculosis Of The Tracheobronchial Tree
Category: BRONCHOSCOPY IN DISEASES OF THE TRACHEA AND BRONCHI
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
The bronchoscopic study
of tuberculosis is very interesting, but only a few cases justify
bronchoscopy. The subglottic infiltrations from extensions of
laryngeal disease are usually of edematous appearance, though they are
much more firm than in ordinary inflammatory edema. Ulcerations in
this region are rare, except as direct extensions of ulceration above
the cord. The trachea is relatively rarely involved in tuberculosis,
but we may have in the trachea the pale swelling of the early stage of
a perichondritis, or the later ulceration and all the phenomena
following the mixed pyogenic infections. These same conditions may
exist in the bronchi. In a number of instances, the entire lumen of
the bronchus was occluded by cheesy pus and debris of a peribronchial
gland which had eroded through. As a rule, the mucosa of tuberculosis
is pale, and the pallor is accentuated by the rather bluish streak of
vessels, where these are visible. Erosion through of peri-bronchial or
peri-tracheal lymph masses may be associated with granulation tissue,
usually of pale color, but occasionally reddish; and sometimes oozing
of blood is noticed. A most common picture in tuberculosis is a
broadening of the carina, which may be so marked as to obliterate the
carina and to bulge inward, producing deformed lumina in both bronchi.
Sometimes the lumina are crescentic, the concavity of the crescent
being internal, that is, toward the median line. Absence of the normal
anterior and downward movement of the carina on deep inspiration is
almost pathognomonic of a mass at the bifurcation, and such a mass is
usually tuberculous, though it may be malignant, and, very rarely,
luetic. The only lesion visible in a tuberculous case may be
cicatrices from healed processes. In a number of cases there has been
a discharge of pus coming from the upper-lobe bronchus.
[Fig. 96.--The author's tampons for pulmonary hemostasis by
bronchoscopic tamponade. The folded gauze is 10 cm. long; the braided
silk cord 60 cm. long.]
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