الفهرس | Only 14 pages are availabe for public view |
Abstract Despite the initial clinical suspicion of TB, when a patient s sputum smear results are negative for AFB, the diagnosis of TB may by missed. For those patients with a high clinical suspicion, clinicians must face the dilemma of empirically treating or waiting for up to 8 weeks for the final culture results. Aim of the Work: The aim of the present work is to study the role of bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB) in the diagnosis of patients suspected to have tuberculosis whose sputum smear were negative or who could not produce sputum. Methods: The present study comprised 23 patients (18 males and 5 females), their mean age was 45.04 + 9.83 with age ranging from 2664 years. All patients were subjected to: (1) Thorough history taking and clinical examination. (2) Plain chest xray posteroanterior and lateral views. (3) ZiehlNeelsen stain of sputum for AFB. (4) Bronchoscopic procedures, a. Bronchoalveolar lavage (BAL), b. Transbronchial lung biopsy. RESULTS: Smear examination of AFB of bronchoalveolar lavage were positive in 56.5% (13 out of 23 patients). Caseating granulomas were detected in 34.8% by histopathological examination of transbronchial lung biopsy. The overall diagnostic yield of the bronchoscopic procedures (BAL + TBLB) were 87% (20 out of 23 patients). The final diagnosis of the present study was 60.9% (14 out of 23 patients) were pulmonary tuberculosis, 26.1% (6 out of 23 patients) were malignancy and only 13% (3 out of 23 patients) were undiagnosed. CONCLUSIONS: Fiberoptic bronchoscopy (FOB) is simple, safe method (with little complications), rapid and cost effective in the diagnosis of smear negative pulmonary tuberculosis. Fiberoptic bronchoscopy (FOB) with BAL and TBLB is mandatory, and must be used in those patients with negative smear. |