Current perspectives on endobronchial tuberculosis

Endobronchial tuberculosis (EBTB) is the tuberculous infection of the tracheobronchial tree, with microbial and histopathological evidence. EBTB is present in 10-40% of patients with active tuberculosis. It can easily be confused with other diseases since the clinical findings are non specific. A clear chest X-ray does not exclude the diagnosis because the X-ray appearances may be normal in 20% of patients. A "tree-in-bud" appearance is a characteristic high resolution computed tomography (HRCT) appearance in EBTB. Bronchoscopic examination is the key to diagnosis, and CT and bronchoscopy are the methods used for the assessment of treatment options. Early diagnosis with prompt treatment is important to prevent the serious complications of EBTB, such as bronchostenosis and bronchiectasis. Antituberculous chemotherapy is effective in controlling the infection but may not preclude residual bronchostenosis. Corticosteroid therapy for the prevention of bronchial stenosis remains controversial. This article presents a clinical, radiological and pathological overview of EBTB, with the current treatment options.