Despite the rapid advancement in diagnostic and therapeutic modalities, endobronchial tuberculosis (EBTB), defined as tuberculous infection of the tracheobronchial tree, continues to remain challenging for clinicians. Nonspecific respiratory symptoms along with normal chest radiograph in 10–20% of cases may be alleged for the diagnostic delay. Variable diagnostic yield with sputum microscopy might further compound the problem. In such cases, high resolution computed tomography (HRCT) works as a more sensitive tool and demonstrates involvement of tracheobronchial tree described classically as “tree-in-bud” appearance. Bronchoscopic biopsy is considered the most reliable method for confirmation of the diagnosis with 30% to 84% positivity in different series. Evolution of the disease is also unpredictable with frequent progression to bronchostenosis, therefore requiring regular follow-up and early intervention to halt the natural course. This review article elaborates various aspects of the disease with specific focus on diagnostic dilemma and recent advances in interventional bronchoscopy. In addition, this discussion evokes optimism for further research and introduction of innovative therapeutic modalities. 1. Introduction “The struggle has caught hold along the whole line and enthusiasm for the lofty aim runs so high that a slackening is no longer to be feared. If the work goes on in this powerful way, then the victory must be won.” While these concluding words of Nobel Laureate addressed on December 12, 1905, reflect optimistic attitude and confidence of Robert Koch, discoverer of Mycobacterium tuberculosis, unfortunately the situation has not improved even after more than 100 years. In 2011, approximately 9 million people suffered from tuberculosis and 1.4 million died, with 60% of cases in Asia and 24% in Africa [1]. With this huge overall burden of the disease and associated morbidity and mortality, it is worthwhile to discuss a specific form of tuberculosis known as endobronchial tuberculosis (EBTB) because of challenges associated with diagnosis as well as prognosis. Endobronchial tuberculosis is defined as tuberculous infection of the tracheobronchial tree with microbial and histopathological evidence [2]. Clinicians encounter difficulties in each and every aspect related to this entity and diagnosis is usually delayed because of nonspecific symptoms. Even after accurate diagnosis is established, clinical course is quite variable with frequent progression to bronchostenosis. The incidence rate of bronchostenosis may be up to 68% in initial 4 to 6
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