Patient: Male, 36 years old, cough lasting about one month, hemoptysis, first chest CT findings of right lower lobe bronchial stenosis and right lower lung segmental atelectasis with multiple nodular and nodule-like shadows, proliferative tuberculosis was considered likely. Bronchofiberscopy showed: right lower lobe bronchial basal segment scar stenosis. Biopsy: chronic inflammatory cell infiltration was seen in the bronchial tissue of the right lower lobe basal segment microscopically, and a small number of multinucleated giant cells were seen and consistent with chronic inflammation, not excluding tuberculosis or other granulomatous inflammation. Further clinical examination is recommended. Antacid bacilli (-), the doctor recommended inflammatory treatment. I would like to ask: 1. Are these symptoms not related to Ca? If it is only tuberculosis, can it be cured by medication only? Do I need to undergo surgery such as bronchodilation? Wen Wenpei, Department of Tuberculosis, Guangdong Tuberculosis Control Center
Wen Wenpei, Department of Tuberculosis, Guangzhou Chest Hospital.
If the bronchial tuberculosis is diagnosed, the bronchial tuberculosis should be treated by fibrinoscopy on the basis of chemotherapy with effective tuberculosis drugs, and the bronchial tuberculosis should be treated by fibrinoscopy before scar formation. In cases of bronchial tuberculosis, local debridement should be performed to dilate the tracheal wall and reduce the obstruction caused by scarring. This is an effective treatment for bronchial endotracheal tuberculosis.
Patient: A bronchoscopic biopsy was performed, and the results are as follows: tracheal fiberscopy showed scar stenosis in the right lower lobe bronchial basal segment. The biopsy showed chronic inflammatory cell infiltration in the basal segment of the lower lobe of the right lung and a small number of multinucleated giant cells, consistent with chronic inflammation, not excluding tuberculosis or other granulomatous inflammation. Can this condition be diagnosed as tuberculosis? What is the best treatment? Also, is the atelectasis of the lung caused by TB?
Wen Wenpei, Department of Tuberculosis, Guangzhou Chest Hospital: This expression is consistent with tuberculosis, tuberculosis treatment at the same time, repeated fibrinoscopic assisted treatment of endobronchial tuberculosis, if the presence of other diseases is ruled out, pulmonary atelectasis should be caused by scar stenosis of endobronchial tuberculosis.
Patient: Thank you for your patience. The biopsy results we had before do not completely exclude the existence of other diseases?
Wen Wenpei, Department of Tuberculosis, Guangzhou Chest Hospital: The biopsy results have not confirmed the diagnosis of tuberculosis, and further tests are needed! At present, the overall impression is that only pathology or sputum examination is the golden indicator to confirm the diagnosis of tuberculosis. For the time being, the treatment is based on tuberculosis, and if the effect is obvious, it proves that the diagnosis of tuberculosis is correct.
Patient: Thank you, Dr. Wen, for your very patient answer! One thing I don’t understand: is pathological analysis different from biopsy?
Wen Wenpei, Department of Tuberculosis, Guangzhou Chest Hospital: Biopsy is a way to take specimens, but the quality of the specimens taken out, such as the specific degree of the disease, the experience of the pathologist and other factors will affect the pathologist’s analysis and judgment. If the specimen is taken in the center of the lesion, the pathologist may be able to draw a definite conclusion because of the strong characteristics of the disease, while the pathologist may draw an uncertain conclusion if the lesion is only in the periphery or if the disease has just started to develop and the characteristic pathological tissue has not been formed. It is recommended that the clinician conduct further tests to clarify the diagnosis. Medicine is so full of uncertainty. I don’t know if you understand this explanation?
One more word, the doctor and patient should trust each other, improve communication, to overcome the disease!