Should bronchoscopy be performed in the evaluation of suspected pediatric pulmonary tuberculosis?

Background: Pulmonary tuberculosis (PTB) infection in children is difficult to diagnose. Objective: To evaluate the effectiveness of fiberoptic bronchoscopy in the diagnosis of PTB. Methods: Four hundred twenty-two children underwent bronchoscopic evaluation. The study population was composed of 80 children (study group) who were suspected of having PTB and 342 children with chronic cough or recurrent/persistent pneumonia (control group). Videotape reviews of each bronchoscopy were correlated with the results of smears and cultures. Results: The majority of children in the study group (54 of 80 children) were new immigrants from Ethiopia, while most of the control group (323 of 342 children) were born in Israel. Among patients in the control group, physical anomalies such as laryngotracheomalacia were more common among children in the control group (105 of 342 children) compared with those in the study group (5 of 80 children; p < 0.03). In the study group, external compression of the right main bronchus, usually at the entrance, was more common (32 of 80 children) compared with the control group (6 of 342 children; p < 0.001). Cultures from BAL fluid revealed Mycobacterium tuberculosis in 3 of the 80 children from the study group compared with 2 children from the control group (p < 0.08). The children with positive cultures from the control group had external compression of the right main bronchus that had been documented by bronchoscopy. Conclusion: Bronchoscopy in children with suspected PTB has a low yield and does not significantly aid bacteriologic confirmation. External compression at the entrance to the right main bronchus is suggestive of PTB infection.