Chest
Volume 113, Issue 2, February 1998, Pages 344-350
Journal home page for Chest

Clinical Investigations: Inhalation/Pneumoconiosis
Bronchial Stenosis Due to Anthracofibrosis

https://doi.org/10.1378/chest.113.2.344Get rights and content

Study objectives

To define the clinical characteristics of the patients showing bronchoscopic findings of bronchial narrowing or obliteration with black pigmentation on overlying mucosa (we named this finding as “anthracofibrosis”), and to determine the association of anthracofibrosis with tuberculosis.

Patients and methods

The subjects of this study consisted of 28 patients; 8 men and 20 women, ranging in age from 42 to 86 years. The distinctive clinical features, natures of bronchoscopic lesions, and radiologic findings were analyzed retrospectively and summarized. Bacteriologic studies and results of pathologic examinations were also assessed.

Results

Chief complaints were cough (20/28) and dyspnea on exertion (17/28). The abnormal bronchoscopic findings were identified most frequently in the right middle lobe bronchus (n=21/28) while more than one part of the bronchial tree was narrowed in 22 patients. Abnormalities of bronchial airways on CT were associated with peribronchial cuffs of soft tissue or surrounding lymph nodes. In 17 patients, active tuberculous infection was confirmed either bacteriologically (n=15) and/or histologically (n=8). Pathologic study of the lesion obtained by bronchoscopic biopsy or thoracotomy showed dense bronchial and/or peribronchial fibrosis with interspersed black pigments.

Conclusions

These findings strongly suggest that bronchial stenosis or obliteration with anthracotic pigmentation in the mucosa was caused by a fibrotic response to active or old tuberculous infection. To prevent the spread of tuberculosis and avoid unnecessary invasive procedures, detailed examinations for the presence of active tuberculosis should be performed in patients with this unique bronchoscopic finding.

Section snippets

Materials and Methods

Among a total of 908 patients who underwent bronchoscopy at Samsung Medical Center from November 1994 to December 1995, anthracofibrosis was diagnosed in 28 patients. Diagnosis of anthracofibrosis was made solely on the basis of bronchoscopic findings. Patients in whom bronchoscopy revealed definite narrowing or obliteration of lobar or segmental bronchi with anthracotic pigmentations in the surrounding mucosa were considered to have anthracofibrosis and were included in this analysis. Patients

Results

Twenty patients had cough with variable amounts of sputum and 17 patients complained of dyspnea on exertion. Other complaints were fever, weight loss, general weakness/fatigue, chest discomfort, and hemoptysis (Table 1). Two patients were asymptomatic. These two patients were referred to our hospital because of radiographic abnormality on routine chest radiographic evaluation. The most common physical finding was wheezing sound on auscultation (8/28). Enlargement of peripheral lymph node was

Discussion

Characteristic features of the patients with bronchial stenosis due to anthracofibrosis in our study were as follows: (1) preponderance of older female patients; (2) no association with pneumoconiosis or smoking; (3) chief complaints of cough and dyspnea without constitutional symptoms; (4) segmental or lobar consolidation on simple chest radiographs; (5) abnormalities of bronchial airways with peribronchial cuffs of soft tissue or surrounding lymph nodes on chest CT; (6) most frequent

References (21)

There are more references available in the full text version of this article.

Cited by (141)

  • Pneumoconioses

    2022, Practical Pulmonary Pathology: A Diagnostic Approach
  • Biomass Fuel Exposure and Lungs: Unraveling the Imaging Conundrum

    2021, Current Problems in Diagnostic Radiology
    Citation Excerpt :

    Hence, it is speculated that BAF may be a subtype of mediastinal fibrosis.25 Even the initial description of BAF by Chung et al mentions the possibility of this hypothesis.3 Mediastinal fibrosis has more extensive involvement of mediastinal structures causing more variable clinical and imaging manifestations which may help to differentiate it from BAF.

  • Occupations With Exposure to Crystalline Silica

    2018, Practical Pulmonary Pathology: A Diagnostic Approach A Volume in the Pattern Recognition Series
View all citing articles on Scopus
View full text