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CT Differentiation of Anthracofibrosis from Endobronchial Tuberculosis

Hyun Jin Park1, Seog Hee Park1, Soo Ah Im1, Young Kyoon Kim2 and Kyo-young Lee3

1 Department of Radiology, Kangnam St. Mary's Hospital, College of Medicine, Catholic University of Korea, 505 Banpo-dong Seocho-gu, Seoul, 137-040, South Korea.
2 Department of Internal Medicine, Kangnam St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea.
3 Department of Pathology, Kangnam St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea.


Figure 1
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  		Fig. 1A —81-year-old woman with anthracofibrosis who presented with cough and sputum. Axial CT scan obtained with lung window setting at level of right main pulmonary artery shows smooth luminal narrowing (arrows) at segmental bronchi of right upper lobe.

 

Figure 2
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  		Fig. 1B —81-year-old woman with anthracofibrosis who presented with cough and sputum. Contrast-enhanced CT scan at same level as A shows enlarged nodes around right upper lobe bronchus (black arrows), in subcarinal region (arrowhead), and around left upper lobe bronchus (white arrow).

 

Figure 3
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  		Fig. 1C —81-year-old woman with anthracofibrosis who presented with cough and sputum. Unenhanced CT scan at same level as A and B shows tiny hyperdense foci (arrows) within enlarged nodes.

 

Figure 4
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  		Fig. 1D —81-year-old woman with anthracofibrosis who presented with cough and sputum. Bronchoscopic image shows luminal narrowing of right upper lobe bronchus with focal deposition of black pigmentation (arrows). Pathologic specimen obtained at bronchoscopic biopsy revealed chronic inflammation without granuloma.

 

Figure 5
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  		Fig. 2A —34-year-old woman with endobronchial tuberculosis who presented with dyspnea. Sputum acid-fast stain result was positive for acid-fast bacilli. Axial CT scan obtained at lung window setting shows uneven contiguous luminal narrowing (black arrow) of left main and upper lobe bronchi. Multiple small nodules are clustered with linear branching opacities (white arrows).

 

Figure 6
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  		Fig. 2B —34-year-old woman with endobronchial tuberculosis who presented with dyspnea. Sputum acid-fast stain result was positive for acid-fast bacilli. Contrast-enhanced CT scan at same level as A shows focal soft-tissue attenuation around stenotic airway (arrow).

 

Figure 7
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  		Fig. 2C —34-year-old woman with endobronchial tuberculosis who presented with dyspnea. Sputum acid-fast stain result was positive for acid-fast bacilli. Bronchoscopic image shows diffuse stenosis of left main bronchus with luminal irregularity. Left main bronchus is hyperemic with purulent secretions. Pathologic specimen obtained at bronchoscopic biopsy revealed chronic inflammation and epithelioid granuloma with caseous necrosis.

 

Figure 8
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  		Fig. 3A —82-year-old woman with anthracofibrosis who presented with dyspnea. Axial CT scans obtained at lung window setting (main bronchus level, A; right middle lobe bronchus level, B; right inferior pulmonary vein level, C) show multifocal smooth bronchial narrowing of segmental bronchi of three lobes of right lung and left upper lobe (straight arrows, A–C). Both main bronchi are preserved. There is no contiguity in disease extent. Volume loss of right middle lobe (curved arrow, C) is evident.

 

Figure 9
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  		Fig. 3B —82-year-old woman with anthracofibrosis who presented with dyspnea. Axial CT scans obtained at lung window setting (main bronchus level, A; right middle lobe bronchus level, B; right inferior pulmonary vein level, C) show multifocal smooth bronchial narrowing of segmental bronchi of three lobes of right lung and left upper lobe (straight arrows, A–C). Both main bronchi are preserved. There is no contiguity in disease extent. Volume loss of right middle lobe (curved arrow, C) is evident.

 

Figure 10
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  		Fig. 3C —82-year-old woman with anthracofibrosis who presented with dyspnea. Axial CT scans obtained at lung window setting (main bronchus level, A; right middle lobe bronchus level, B; right inferior pulmonary vein level, C) show multifocal smooth bronchial narrowing of segmental bronchi of three lobes of right lung and left upper lobe (straight arrows, A–C). Both main bronchi are preserved. There is no contiguity in disease extent. Volume loss of right middle lobe (curved arrow, C) is evident.

 

Figure 11
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  		Fig. 3D —82-year-old woman with anthracofibrosis who presented with dyspnea. Contrast-enhanced CT scan at same level as A shows multiple enlarged nodes around stenotic bronchi and high-attenuation foci (arrowheads) in subcarinal region.

 

Figure 12
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  		Fig. 4A —56-year-old man with history of endobronchial tuberculosis 10 years in past who presented with dyspnea. Contrast-enhanced CT scan at level of carina shows smooth luminal narrowing of right main bronchus (straight arrow). Right upper lobe bronchus is completely obstructed, resulting in peripheral atelectasis (curved arrow).

 

Figure 13
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  		Fig. 4B —56-year-old man with history of endobronchial tuberculosis 10 years in past who presented with dyspnea. Contrast-enhanced CT scan at level of aortic arch shows luminal narrowing of distal trachea with evenly thickened tracheal wall (straight arrow). Collapse of right upper lobe (curved arrow) is evident.

 

Figure 14
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  		Fig. 4C —56-year-old man with history of endobronchial tuberculosis 10 years in past who presented with dyspnea. Bronchoscopic image shows bronchostenosis of right main bronchus. Opening of right upper lobe bronchus is obstructed without evidence of mucosal change.

 

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