The incidence, distribution and morphology of lymphadenogenous perforative bronchial scars in adults.

The interest which is shown in the more recent European literature in perforative bronchial lesions is mainly the result of two factors: the more frequent application of radiologic1’ 2 bronchoscopic ‘ and bronchographic4 technics in the evaluation of bronchial lesions, and the increased emphasis on the importance of the lymphatic system in the pathogenesis of pulmonary tuberculosis. The latter factor is further brought into prominence by the relative resistance of tuberculous lymph nodes to the effect of modern antituberculosis therapy.2’ 5 Over 1,000 references on perforations of tuberculous lymph nodes into the bronchial tree are now available.6 Fresh lymphadenogenous bronchial perforations result in characteristic, localized, circumscribed bronchial lesions which differ morphologically and pathogenetically from the caseous, ulcerative bronchial lesions which originate from implantation and spread of tuberculous infection by continuity.7 They can be observed in all the phases of pulmonary tuberculosis.1’ 8-10 Although a large percentage of them heal without sequelae,’1 localized residual scars at typical sites frequently remain and can often be detected many years later at autopsy. The relative scarcity of reports on perforative bronchial lesions in the American literature suggested the possibility that perforative bronchial lesions and scars might be less common in. the United States than in Europe. Hence the following study.