Bronchiectasis complicated by tuberculosis was studied bronchographically and/or histologically on removed specimens on 299 patients. As a contrast medium 60% Urokolin oil suspension was instilled into the bronchus by means of Metras' catheter and following results were obtained.
1) Bronchiectasis was found in 208 cases (69.9%). Of this number cavities were present in the affected lung in 143 cases. The incidence of bronchiectasis was found increased with increase of duration of pulmonary tuberculosis. Of 47 cases in which tuberculosis had been present for 6 months bronchiectatic changes were found in 26 cases (55.3%). Of 23 cases in which tuberculosis had been present with cavitation for 6 months 17 cases (73.5%) showed bronchiectasis, and of 36 cases in which tuberculosis had been present more than 5 years, 35 cases (97.2%) showed bronchiectasis. However, of 24 cases in which tuberculosis had been present for 6 months and in which no avitation was present, 9 cases showed bronchiectasis and of 23 in which tuberclosis had been present 15 cases (73.9%) showed bronchiectasis.
2) Relationship between various types of pulmonary tuberculosis and Bronchiectasis:
Type Number of cases studied Bronchiectasis
H 8 none
B 67 58 (86.6%)
C 183 93 (50.8%)
D. 18 11 (61.1%)
OK 4 3 (75.0%)
OT 19 9 (47.5%)
3) Pattern of bronchiectasis
The incidence of column shaped bronchiectasis was found decreased as the duration of tuberuculosis process increased, while club and rosary shaped ones showed increase with the increase of the duration of tuberculosis process.
4) Location of involved bronchiectasis
Right side: B1, B2, and B3 were involved in 95 (82.6%) of 116 cases. B6 was involved next in frequency.
Left side: Majority involved were B1 plus, 2, and B3.
These findings indicate a distinct difference of bronchiectasis complicated by tuberculosis from spontaneous one.
5) No remarkable changes were noted in the course of one year in 73 cases of bronchiectasis which were examined regularly at 3 month intervals.
6) Symptoms of bronchiectasis
Group A. With average amount of cough, sputum, blood tinged sputum and/or hemoptysis. Group B. No symptoms but tubercle bacilli were found in sputum.
Group C. No symptoms and no tubercule bacilli in sputum.
Group A. constituted 61 cases (29.3%) which are mostly of rosay and grape shaped ectasis located in the central region.
Group B and C which are mostly of column and club shaped are seen in peripheral parts.
7) Treatment
Chemotherapy was given to all cases irrespective of whether or not a surgical operation had to be required.
A. Surgical operation
Although it is too early to discuss the long range results, patients with a few exceptions have taken good turn after operation.
B. Chemotherapy
Among those who received only chemotherapy good results were obtained in
As shown in the above figure club shaped ectasis responded better to chemotherapy than other types.
8) Histological studies of the removed lungs.
Observations made on 64 cases showed that the bronchial mucosa has general tendency to form fine winkles and to exfoliate its epithelium. Some parts were seen papilliformed projecting into the lumen. Cellular infiltrations were seen in the submucosa. In only one case tuberculous lesion was noted in the submucosal tissue, and all the other specimens showed non-specific infiltrations. In some areas cellular infiltrations were so marked that the muscular tissues were found broken or atrophied. While a very few cases showed tuberculous infiltration, non-specific infiltrations and increase of fibrous tissues and athelectasis around bronchi are observed. Therefore bronchiectasis accompaning pulmonary tuberculosis is considered to be due to lymphogenic infection around the bronchi.