Prediction of Anthracofibrosis Based on Clinico-Radiographic Findings

PURPOSE: Because anthracofibrosis (AF) is associated with tuberculosis (TB), detection of AF is clinically relevant in Korea, a TB endemic region. We thus sought to develop and validate a predictive model for AF using clinical radiographic data. MATERIALS AND METHODS: Between January 1, 2008 and March 31, 2014, 3849 adult patients who underwent bronchoscopies were retrospectively included from an observational registry. We dichotomized patients based on the presence (n=167) or absence (n=242) of AF. After analyzing their clinico-radiographic characteristics, a logistic prediction model was developed. An area under the curve (AUC) was drawn using the weighted score in logistic regression model. To evaluate the degree of overfitting of the predictive model, a 5-fold cross-validation procedure was performed. RESULTS: In multivariate logistic regression, clinical findings such as age >70 years, female gender, active TB, and computed tomography findings including atelectasis, stenosis, bronchial wall thickening, enlarged and calcified lymph nodes were significant diagnostic predictors for AF. The weighed score had an AUC of 0.939 [95% confidence interval (CI)=0.911–0.960], similar to the AUC obtained from internal validation (AUC=0.926, 95% CI=0.896–0.949). CONCLUSION: The prediction model may be helpful for predicting AF based only on clinical and radiographic findings. However, further external validation is necessary.

Relationship between bronchial anthracofibrosis and endobronchial tuberculosis

BACKGROUND/AIMS: Various pulmonary diseases may be associated with bronchial anthracofibrosis (BAF). Our aim was to identify a relationship between BAF and endobronchial tuberculosis (EBTB). METHODS: In total, 156 patients, diagnosed with EBTB using bronchoscopy, between June 1999 and May 2008, were included. Clinical and bronchoscopic findings between patients with BAF (n = 72, BAF group) and without BAF (n = 84, non-BAF) were analyzed retrospectively. RESULTS: The crude odds ratio (OR) of BAF for EBTB was 8.88 (95% confidence interval, 6.37 to 12.37). On multivariate analysis, adjusting for age, history of biomass smoke exposure, and comorbidities, the most significant independent factor for EBTB was a history of biomass smoke exposure (adjusted OR, 17.471; adjusted p < 0.001). EBTB was more frequent in the right lung, particularly the right middle lobar bronchus, in the BAF group. Actively caseating, edematous-hyperemic, and ulcerative were the major types, with 77 (49%), 33 (21%), and 31 cases (20%), respectively. The BAF group had more ulcerative type, while the non-BAF group had more actively caseating type. The duration of EBTB treatment was similar between the groups. No significant difference was observed in the development of complications during treatment and posttreatment bronchostenosis between the groups. CONCLUSIONS: These findings suggest that BAF may be a risk factor for EBTB and affect the location and morphological type at the time of EBTB development.

Bronchial Anthracofibrosis and Macroscopic Tissue Pigmentation on EBUS-TBNA Predict a Low Probability of Metastatic Lymphadenopathy in Korean Lung Cancer Patients

The identification of mediastinal lymph nodes (LNs) in lung cancer is an important step of treatment decision and prognosis prediction. The endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely used to assess the mediastinal LNs and tissue confirmation in lung cancer. As use of bronchoscopy or EBUS-TBNA has been increased, bronchial anthracofibrosis (BAF) has been detected frequently. Moreover, BAF is often accompanied by mediastinal lymphadenopathy and showed false-positive positron emission tomography uptake, which mimics metastatic lymphadenopathy in lung cancer patients. However, clinical implication of BAF during bronchoscopy is not well understood in lung cancer. We retrospectively reviewed 536 lung cancer patients who performed EBUS-TBNA and observed BAF in 55 patients. A total of 790 LNs were analyzed and macroscopic tissue pigmentation was observed in 228 patients. The adjusted odds ratio for predicting malignant LN was 0.46 for BAF, and 0.22 for macroscopic tissue pigmentation. The specificity of BAF and macroscopic tissue pigmentation for predicting a malignant LN was 75.7% and 42.2%, respectively, which was higher than the specificity of using LN size or standard uptake value on PET. In conclusion, BAF and macroscopic tissue pigmentation during EBUS-TBNA are less commonly found in malignant LNs than reactive LNs in Korean lung cancer patients.

General anesthesia in a patient with known bronchial anthracofibrosis: A case report / 대한마취과학회지

Bronchial anthracosis was recently defined in the English radiology literature as a luminal narrowing associated with anthracotic pigmentation on bronchoscopy without a relevant history of pneumoconiosis or smoking. Anthracosis refers to the presence of carbon particles in the lungs, not to a disorder per se. Anthracofibrotic lesions carry the potential risk of massive hemorrhage during endobronchial procedures. This report describes a case of general anesthesia for a left modified radical mastectomy due to an intraductal carcinoma in a patient with known bronchial anthracofibrosis.

The Clinical Significance of Bronchial Anthracofibrosis Associated with Coal Workers' Pneumoconiosis / 결핵및호흡기질환

BACKGROUND: In previous study, most patients with bronchial anthracofibrosis (BAF) were non-miners, and non-occupational old aged females. However, the clinical significance of BAF in patients with coal workers' pneumoconiosis (CWP) is unknown. METHODS: Among patients with CWP who transferred to our hospital for an evaluation of associated pulmonary diseases, 32 patients who had undergone a bronchofibroscopy (BFS) and chest computed tomography (CT) examination were evaluated for the association of the BAF using a retrospective chart review. RESULTS: Nine of the 32 CWP patients (28%) were complicated with BAF. Four of the 16 simple CWP patients (25%) were complicated with BAF. According to the International Labor Organization (ILO) classification by profusion, 2 out of 3 patients in category 1, 1 out of 8 patients in category 2 and 1 out of 3 patients in category 3 were complicated with BAF. Five out of 16 complicated CWP patients were complicated with BAF. Three out of 7 patients in type A and 2 out of 5 patients in type C were complicated with BAF. CWP patients with BAF had significantly greater multiple bronchial thickening and multiple mediastinal or hilar lymph node enlargement than the CWP patients without BAF. There was no difference in the other clinical features between the CWP patients with BAF and those without BAF. CONCLUSION: Many CWP patients were complicated with BAF. The occurrence of BAF was not associated with the severity of CWP progression. Therefore, a careful evaluation of the airway with a bronchoscopy examination and chest CT is warranted for BAF complicated CWP patients who present with respiratory symptoms and signs, even ILO class category 1 simple CWP patients.

Clinical and Radiological Characteristics of Non-Tuberculous Bronchial Anthracofibrosis / 결핵및호흡기질환

BACKGROUND: Bronchial anthracofibrosis, which is defined as bronchial narrowing with black pigmentation of the overlying bronchial mucosa, is frequently associated with tuberculosis. The aim of this study was to examine the relationship between bronchial anthrocofibrosis and to identify the clinical and radiological characteristics of non-tuberculous bronchial anthracofibrosis. METHODS: All patients who showed bronchial anthracofibrosis in more than one segment on a bronchoscopic examination from January 2003 to July 2006 at Kangnam St. Mary's hospital were enrolled in this study. The underlying diseases, baseline clinical characteristics, characteristic findings on a computed tomogram (CT) of the chest, pathologic findings of the bronchial mucosa, and the clinical response to steroid therapy were analyzed retrospectively. RESULTS: A total 54 patients (19 males, 35 females) were enrolled with a mean age of 75 years. The most common presenting symptoms were cough, sputum and dyspnea. The predominant X-ray findings were peribronchial soft tissue attenuation with or without calcification, mediastinal lymphadenopathy with or without calcification and atelectasis. Fourteen non-tuberculous anthracofibrosis patients were treated with steroid. Nine patients were improved clinically, and 6 patients were improved radiologically. CONCLUSION: Bronchial anthracofibrosis is frequently associated with various pulmonary diseases not only tuberculosis but also COPD pneumonia etc.

Clinical and Radiological Characteristics of Non-Tuberculous Bronchial Anthracofibrosis / 결핵및호흡기질환

BACKGROUND: Bronchial anthracofibrosis, which is defined as bronchial narrowing with black pigmentation of the overlying bronchial mucosa, is frequently associated with tuberculosis. The aim of this study was to examine the relationship between bronchial anthrocofibrosis and to identify the clinical and radiological characteristics of non-tuberculous bronchial anthracofibrosis. METHODS: All patients who showed bronchial anthracofibrosis in more than one segment on a bronchoscopic examination from January 2003 to July 2006 at Kangnam St. Mary's hospital were enrolled in this study. The underlying diseases, baseline clinical characteristics, characteristic findings on a computed tomogram (CT) of the chest, pathologic findings of the bronchial mucosa, and the clinical response to steroid therapy were analyzed retrospectively. RESULTS: A total 54 patients (19 males, 35 females) were enrolled with a mean age of 75 years. The most common presenting symptoms were cough, sputum and dyspnea. The predominant X-ray findings were peribronchial soft tissue attenuation with or without calcification, mediastinal lymphadenopathy with or without calcification and atelectasis. Fourteen non-tuberculous anthracofibrosis patients were treated with steroid. Nine patients were improved clinically, and 6 patients were improved radiologically. CONCLUSION: Bronchial anthracofibrosis is frequently associated with various pulmonary diseases not only tuberculosis but also COPD pneumonia etc.

Mycobacterium Kansasii Disease Presenting As a Lung Mass and Bronchial Anthracofibrosis / 결핵및호흡기질환

The incidence of Mycobacterium kansasii pulmonary diseases are on the increase in Korea with the higher probability of occurrence in middle-aged and older men with underlying lung diseases Among nontuberculosus mycobacterial (NTM) infections, the clinical features of M. kansasii pulmonary infection are most similar to those of tuberculosis (TB). The chest radiographic findings of M. kansasii infection are almost indistinguishable from those of M. tuberculosis (predominance of an upper lobe infiltration and cavitary lesions), even though some suggest that cavities are more commonly thin-walled and have less surrounding infiltration than those of typical TB lesions. Although there are reports on the rare manifestations of M. kansasii infections, such as endobronchial ulcer, arthritis, empyema, cutaneous and mediastinal lymphadenitis, cellulites and osteomyelitis, the association with bronchial anthracofibrosis has not yet been reported. This report describes the first case of M. kansasii infection presenting as a lung mass in the right lower lobe with accompanying bronchial anthracofibrosis.

Ventilatory Dynamics according to Bronchial Stenosis in Bronchial Anthracofibrosis / 결핵및호흡기질환

BACKGROUND: Bronchial anthracofibrosis usually manifest as a form of obstructive airway disease, and can be accompanied by parenchymal diseases such as pneumonia, and pulmonary tuberculosis. This study investigated the ventilatory dynamics according to the severity of bronchial stenosis in patients with bronchial anthracofibrosis. Method : One hundred and thirteen patients with bronchial anthracofibrosis that was confirmed by bronchoscopy and who had undergone a pulmonary function test were enrolled in this study group. The correlation coefficients between the pulmonary functional parameters and the number of lobes with bronchial stenosis were investigated. RESULTS: The incidence of ventilatory dysfunction was 56(49.6%) for obstructive, 8(7.1%) for restrictive, 2(1.8%) for mixed, and 47(41.6%) for a normal pattern. The FEV1/FVC, FEF25~75%, FEF25%, FEF50%, FEF75%, and PEF showed a significant negative correlation (p<0.05) and the Raw had a significant positive correlation with the number of lobes with bronchial stenosis(p<0.001). CONCLUSION: These findings suggest that the most common abnormality of the ventilatory function in bronchial anthracofibrosis is an obstructive pattern with a small airway dysfunction according to the severity of bronchial stenosis.

The CT Findings of Bronchial Anthracofibrosis: Comparison of Cases with or without Active Tuberculosis

PURPOSE: To assess the CT findings of bronchial anthracofibrosis with or without active tuberculosis. MATERIALS AND METHODS: Analysis of the CT scans of 35 patients with bronchoscopically proven anthracofibrosis revealed that 25 were negative for active tuberculosis and ten were positive. Bronchial and pleural lesions, pulmonary parenchymal lesions, and mediastinal/hilar lymph nodes were retrospectively evaluated. RESULTS: Common radiologic findings of anthracofibrosis included diffuse bronchial narrowing (50%), wall thickening (37%), and mass-like soft tissue density in central bronchi (8%). The right middle lobe was most commonly involved (31%). Common findings of pulmonary parenchymal lesions included consolidation (37%), atelectasis (31%), and ground-glass opacity (10%). These bronchial or pulmonary parenchymal findings were common in patients with or without active tuberculosis. Findings of multiple poorly defined small nodules, including branching opacities and consolidation with internal low density were seen only in patients with active tuberculosis (p<0.01), while enlarged mediastinal or hilar lymph nodes were frequently observed in patients with or without active tuberculosis. Necrotic lymph nodes were present only in those with active tuberculosis (p<0.05). CONCLUSION: When CT scans depict central bronchial narrowing, wall thickening, or mass-like soft tissue density with atelectasis or consolidation, especially in older patients without a distinct central lung mass lesion, anthacofibrosis should be included in the differeatial diagnosis. When multiple poorly defined small nodules, including branching opacities, consolidation with internal low density or necrotic lymph nodes are observed, the possibility of concomitant active tuberculosis should be considered.

The Clinical Significances of Bronchial Anthracofibrosis in the Patients with Endobronchial Tuberculosis / 결핵

BACKGROUND: Bronchial anthracofibrosis is one of the main manifestations of lung disease that is related to woodsmoke inhalation, and it is frequently associated with various pulmonary diseases, such as tuberculosis. The purpose of this study was to evaluate the clinical significance of bronchial anthracofibrosis in patients with endobronchial tuberculosis. METHODS: 63 patients, who were diagnosed with endobronchial tuberculosis using bronchoscopy, were included in this study. The patients consisted of 12 males and 51 females, having mean age of 59.5 years. The clinical features, radiologic and bronchoscopic findings between the patients with (37) and without (26) bronchial anthracofibrosis were analyzed retrospectively. RESULTS: When the patients were older, bronchial anthracofibrosis was more frequent. The endobronchial tuberculosis, which was located at the right middle lobal bronchus, was more frequent in the patients with bronchial anthracofibrosis than in the patients without bronchial anthracofibrosis. In the morphologic types of endobronchial tuberculosis, patients with bronchial anthracofibrosis had more edematous-hyperemic and ulcerative types, while patients without bronchial anthracofibrosis had more active caseating. CONCLUSION: These findings suggest that the presence of bronchial anthracofibrosis can possibly influence the locations and morphologic types of endobronchial tuberculosis.

Bronchial Bleeding Induced by Suction in a Patient with Bronchial Anthracofibrosis / 대한마취과학회지

Bronchial anthracofibrosis has recently been defined as a luminal narrowing associated with anthracotic pigmentation on bronchoscopy without a relevant history of pneumoconiosis or smoking. However, bronchial anthracofibrosis and tuberculosis have been strongly suggested to be related. Anthracofibrotic lesions have a potential for massive bleeding during endobronchial procedure. This report describes a case of bronchial bleeding, encountered after anesthesia for radical prostatectomy in a bronchial anthracofibrosis patient.

Evaluation of Tuberculosis Activity in Patients with Anthracofibrosis by Use of Serum Levels of IL-2 sRalpha, IFN-gamma and TBGL(Tuberculous Glycolipid) Antibody / 결핵

BACKGROUND: Anthracofibrosis, a descriptive term for multiple black pigmentation with fibrosis on bronchoscopic examination, has a close relationship with active tuberculosis (TB). However, TB activity is determined in the later stage by the TB culture results in some cases of anthracofibrosis. Therefore, it is necessary to identify early markers of TB activity in anthracofibrosis. There have been several reports investigating the serum levels of IL-2 sRalpha, IFN-gamma and TBGL antibody for the evaluation of TB activity. In the present study, we tried to measure the above mentioned serologic markers for the evaluation of TB activity in patients with anthracofibrosis. METHODS: Anthracofibrosis was defined when there was deep pigmentation (in more than two lobar bronchi) and fibrotic stenosis of the bronchi on bronchoscopic examination. The serum of patients with anthracofibrosis was collected and stored under refrigeration before the start of anti-TB medication. The serum of healthy volunteers (N=16), patients with active TB prior to (N=22), and after (N=13), 6 month-medication was also collected and stored. Serum IL-2 sRalpha and IFN-gamma were measured with ELISA kit (R&D system, USA) and serum TBGL antibody was measured with TBGL EIA kit (Kyowa Inc, Japan). RESULTS: Serum levels of IL-2 sRalpha in healthy volunteers, active TB patients before and after medication, and patients with anthracofibrosis were 640+/-174, 1,611+/-2,423, 953+/-562, and 863+/-401 pg/ml, respectively. The serum IFN-gamma levels were 0, 8.16+/-17.34, 0.70+/-2.53, and 2.33+/-6.67 pg/ml, and TBGL antibody levels were 0.83+/-0.80, 5.91+/-6.71, 6.86+/-6.85, and 3.22+/-2.59 U/ml, respectively. The serum level of TBGL antibody was lower than that of other groups (p<0.05). There was no significant difference of serum IL-2 sRalpha and IFN-gamma levels among the four groups. CONCLUSION: The serum levels of IL-2 sRalpha, IFN-gamma and TBGL antibody were not useful in the evaluation of TB activity in patients with anthracofibrosis. More useful ways need to be developed for the differentiation of active TB in patients with anthracofibrosis.

The clinical investigation for determining the etiology of bronchial anthracofibrosis / 대한내과학회지

BACKGROUND: The bronchial anthracofibrosis has been thought to be a unique clinical syndrome caused by a fibrotic response to active or old tuberculous infection, but recent studies suggest that long-term exposure to woodsmoke may be the cause of the development of bronchial anthracofibrosis and the tuberculosis is thought to be a disease frequently associated with bronchial anthrocofibrosis, not the main etiology. The purpose of this study was to elucidate the relationship between the bronchial anthracofibrosis and the long-term exposure to woodsmoke and tuberculosis through analyses of the clinical features of patients with bronchial anthracofibrosis. METHODS: 166 patients having bronchial anthracofibrosis confirmed by bronchoscopy were included in this study. They were 23 males and 143 females, having mean sge 72.4 years, ranging from 56 to 91. The epidemiologic features, distinctive clinical features, physiologic findings, radiologic findings and bronchoscopic findings were analyzed retrospectively. RESULTS: All the patients living in rural area (129 of 166) had experienced long-term exposure to woodsmoke. The history of tuberculosis was obtained in 52 patients without history of occupational exposure to dust. The predominant chest CT findings were atelectasis, bronchial stenosis and calcified or noncalcified lymph node enlargements. The most common abnormality of pulmonary function was obstructive pattern, observed in 47.8%. The bronchoscopic examination disclosed multifocal anthracotic plaques mostly at the bifurcation of lobar or segmental bronchi, particularly in upper lobe. The bronchial stenosis was frequently observed in right middle and upper lobe. The associated diseases were obstructive airway disease in 56, obstructive pneumonia in 40, active tuberculosis in 36, and lung cancer in 11 patients. CONCLUSION: The bronchial anthracofibrosis, in the patient who has long-term experience to woodsmoke inhalation without any history of environmental exposure to dust, is one of the manifestation of lung disease related to woodsmoke inhalation, and is frequently associated with various pulmonary diseases, including tuberculosis.

Clinical Features of Simple Bronchial Anthracofibrosis which is not Associated with Tuberculosis / 결핵

BACKGROUND: Bronchial anthracofibrosis (BAF) is a dark black or brown pigmentation of multiple large bronchi associated with a fibrotic stenosis or obliteration that is incidentally found during a diagnostic bronchoscopy. Some reporters have suggested endobronchial tuberculosis or tuberculous lymphadenitis as a possible cause of BAF. However, some BAF patients do not have any medical history of tuberculosis. The aim of this study was to elucidate the clinical features of simple BAF patients, which were not associated with tuberculosis. METHODS: We reviewed the patients' charts retrospectively and interviewed all BAF patients who were followed up for 1 year or more. Among the 114 BAF patients, 43 patents (38 %) had no associated tuberculosis, cancer and pneumoconiosis. The clinical characteristics, radiological findings and associated pulmonary diseases of these patients were evaluated. RESULTS: Most patients were non-smokers, old aged, housewifes who resided in a farming village. The common respiratory symptoms were dyspnea, cough and hemoptysis. The predominant X-ray findings were a multiple bronchial wall thickening(89%), bronchial narrowing or atelectasis (76%) and a mediastinal lymph node enlargement with/without calcification (78%). Pulmonary function test usually showed mild obstructive ventilatory abnormalities but no patient showed a restrictive ventilatory pattern and the patients were frequently affected with chronic bronchitis(51%), post-obstructive pneumonia(40%) and chronic asthma(4%). CONCLUSION: Because BAF is frequently associated with chronic bronchitis and obstructive pneumonia as well as tuberculosis, a careful clinical evaluation and accurate differential diagnosis is more essential than empirical anti-tuberculous medication.

Detection of Mycobacterium Tuberculosis in Bronchial Specimens Using a Polymerase Chain Reaction in Patients with Bronchial Anthracofibrosis / 결핵

No abstract availalbe.

Study of Antituberculous Medications in Anthracofibrosis / 결핵

PURPOSE: An anthracofibrosis(AF), dark multiple anthracotic pigmentations combined with narrowing and obstruction of bronchi, was reported to be strongly related with past and active pulmonary tuberculosis. This study was performed to determine whether anti-tuberculous regiemens would be helpful in patients with anthracofibrosis who failed to demonstrate the evidences of pulmonary tuberculosis. METHODS: Twenty-two patients with multiple anthracotic pigmentations in bronchia mucosa with luminal narrowing were enrolled in this study. The bacteriological and histological findings for Mycobacterium tuberculosis was reviwed in each patients. They are composed of 8 males and 14 females ranging from 55 to 85 years old in age. RESULTS: The most common symptoms were coughing(73%, 16/22), followed by sputum(41%, 9/22), dyspnea on exertion (32%, 7/22), and hemoptysis(27%, 6/22). The evidence of pulmonary tuberculosis, defined by positive AFB smear or culture of Mycobacterium tuberculosis from sputum or bronchial washing fluid or histological findings of granuloma with caseous necrosis, were found in eleven patients(50%) and the others has showed no evidences. Among 11 patients without pulmonary tuberculosis, only one patient showed the evidences of pulmonary tuberculosis after 16 months, and the 8 patients still showed no evidence of pulmonary tuberculosis during follow-up periods of ranging from 8 months to 60 months. CONCLUSION: Beause the authracofibrosis is closely related to tuberculosis, it needs to find out extensively the evidences of tuberculosis in patient with authracofibrosis. Chemotherapy for tuberculosis should be administrated only with confirmation of tuberculosis on bacteriologic study.

Anthracofibrosis Mimicking Lung Cancer on CT: MR Imaging Findings

PURPOSE: To describe the MRI findings in the bronchial anthracofibrosis mimicking lung cancer on CT examination. MATERIALS AND METHODS: Ten patients, who showed CT findings mimicking lung cancer, were selected among fifty patients of bronchial anthracofibrosis proven by bronchoscopic biopsy, consisting of two men and eight women, ranging in age from 58 to 79 years old (average age, 68 years old). CT scan and MRI were performed in all patients(n=10). Percutaneous lung biopsy on mass was performed in one patient. MRI findings were analyzed with the emphasis on the signal intensity of the mass (n=4), collapsed lung (n=4) and lymph node (n=10) on axial T1 and T2-weighted images by two radiologists in consensus. No contrast enhancement was used in all cases. RESULTS: CT scan revealed mass(n=4), atelectasis with obstructive pneumonia(n=4) and bronchial wall thickening(n=2). All patients showed enlarged medistinal lymph nodes(n=10). The mass showed low signal intensity on T1WI and T2WI (n=4). The collapsed lung in patients with atelectasis indicated intermediate signal intensity on T1WI and low signal intensity on T2WI (n=4). Nine patients showed low signal intensity of lymph node on T1WI and T2WI, except one patient who showed central high signal intensity with peripheral rim of low signal intensity in right lower paratracheal lymph node on T2WI. CONCLUSION: Low signal intensity of a mass, collapsed lung, and lymph nodes on T2WI in anthracofibrosis patients may be helpful in differentiation of the lesion from lung cancer.