Bronchial Stenosis

MTb may affect the main or lobar bronchi, and the pattern is usually one of bronchial obstruction associated with airway wall thickening and inflammation. Airway strictures most commonly involve the left mainstem bronchus (figure 1).

Figure 1A. MTb Bronchial Stenosis

Frontal chest radiograph in a patient with MTb-induced, left mainstem bronchial stenosis shows volume loss in the left upper lobe (note obscuration of left cardiac border and diminished left lung volume).

 

 

 

Figure 1B. Axial CT Image

Note narrowing of the left mainstem bronchus.

Figure 1C. Coronal Volume Rendered Image

Note stenosis of the left mainstem bronchus.

Figure 1D. Fluoroscopic Image

Note the insertion of a stent to relieve the left mainstem bronchial stenosis.

Tracheal disease is less common than, and usually accompanied by, bronchial disease: MTb preferentially affects the distal portion of the trachea. Airway lesions usually result from local extension of infection from affected lymph nodes or lung parenchyma. They are less commonly related to endobronchial or hematogenous dissemination of MTb. Active infection appears as irregular or smooth, circumferential airway thickening and narrowing, often accompanied by lymphadenopathy and strand-like densities within the mediastinum. Chronic airway stenosis from MTb is due to fibrosis, and is not generally accompanied by other signs of active infection. Chronic stenosis is associated with less wall thickening than is seen with acute infection.

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