Published online Sep 6, 2021. doi: 10.12998/wjcc.v9.i25.7330
Peer-review started: January 23, 2021
First decision: April 29, 2021
Revised: May 11, 2021
Accepted: July 12, 2021
Article in press: July 12, 2021
Published online: September 6, 2021
Processing time: 219 Days and 23.7 Hours
Tracheobronchial tuberculosis (TBTB) is a common subtype of pulmonary tuberculosis. Concomitant diseases often obscure the diagnosis of senile TBTB.
To characterize senile patients with TBTB and to identify the potential causes of misdiagnosis.
One hundred twenty patients with senile TBTB who were admitted to the Anhui Chest hospital between May 2017 and May 2019 were retrospectively analyzed. Patients were classified as diagnosed group (n = 58) and misdiagnosed group (n = 62). Clinical manifestations, laboratory results, radiographic data, and endoscopic findings were compared between the two groups.
Patients in the misdiagnosed group were most commonly diagnosed as pulmonary tuberculosis (non-TBTB, 29/62, 46.8%), general pneumonia (9/62, 14.5%), chronic obstructive pulmonary disease (8/62, 12.9%), and tracheobronchial carcinoma (7/62, 11.3%). The time elapsed between disease onset and confirmation of diagnosis was significantly longer in the misdiagnosed group [median (first quartile, third quartile): 6.32 (4.94, 16.02) mo vs 3.73 (2.37, 8.52) mo]. The misdiagnosed group had lower proportion of patients who underwent bronchoscopy [33.87% (21/62) vs 87.93% (51/58)], chest computed tomography (CT) scan [69.35% (43/62) vs 98.28% (57/58)], and those who showed CT signs of tuberculosis [27.91% (12/62) vs 50% (29/58)] as compared to that in the diagnosed group (P < 0.05). There were no significant between-group differences with respect to age, gender, occupation, clinical manifestations, or prevalence of comorbid chronic diseases (P > 0.05).
Insufficient or inaccurate radiographic or bronchoscopic assessment was the predominant cause of delayed diagnosis of TBTB. Increased implementation and better interpretation of CT scan and early implementation of bronchoscopy can help reduce misdiagnosis of senile TBTB.
Core Tip: Tracheobronchial tuberculosis (TBTB) is commonly misdiagnosed in clinical practice, especially among senile patients. To identify the determinants of misdiagnosis of TBTB, we systematically compared the clinical features and diagnostic workup between senile patients with TBTB that had been correctly diagnosed and those that had been misdiagnosed. Insufficient or inaccurate radiographic or bronchoscopy assessment was the predominant cause of delayed diagnosis of TBTB. Clinical features like age, gender, occupation, clinical manifestations, or prevalence of comorbid chronic diseases were not related to the misdiagnosis of TBTB.