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Tuberculosis Of The Tracheobronchial Tree

Sources: 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 tubercu

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.]