A study consisting of pathological investigation of the draining bronchus obtained
from eight-two (82) cases of pulmonary resection for tuberculosis at the Thoracic
Surgery Section in the 36th Army Hospital Masan, Korea, from 1953 through 1954 in
presented in order to reach some conclusions concerning the relationship of the
pathological changes of the draining bronchus to the pulmonary tuberculosis lesions and
pulmonary tuberculosis lesions and pulmonary resectional therapy for tuberculosis.
The following conclusions were drawn.
1. Pathological investigation of the tuberculous change of the draining bronchus was
performed in eighty-two(82) pulmonary resections for tuberculosis of Korean males.
2. Of eighty-two (82)cases, sixty-nine(69) or 82% were combined with tuberculous
change of the draining bronchus. This high rate of tuberculous change of the draining
bronchus is probably due to the fact pulmonary resection for tuberculosis is usually
performed too late in Korea. I found these tuberculous changes of the draining bronchus
especially in all cases of cavities and tuberculomas which are beginning to undergo
liquefaction.
3. Morphologically, these tuberculous changes of the draining bronchus were classified
in four groups as follows :
a. Caseous ulcerative type.
b. Exudative infiltrative type.
c. Productive infiltrative type, and
d. Solitary tubercle formation type, (See annexed photo)
I wish to indicate that in case of initial cavity, and giant cavity, cirrhotic cavity, and
giant cavity, the tuberculous change of the draining bronchus revealed usually the
"Exudative infiltrative type".
4. There are three groups of pathological changes of the tuberculous draining
bronchus as to their spread and localization.
In the first group, the tuberculous change of the draining bronchus begins at the
entry of the cavity and continues to the stump, extending over the entire length of the
bronchus.
In the second group, the tuberculous changes of the draining bronchus is limited to
the entry of the draining bronchus tot the cavity.
In the third group, a solitary tubercle is formed separately in the stump of the
draining bronchus at a distance from the tuberculous changes at the entry of the
bronchus to the cavity.
In the author's study, while the tuberculous change of the draining bronchus of the
cirrhotic cavities, giant cavities, and multiple cavities usually belong to the first group,
in initial cavities and liquifying tuberculomas the tuberculous change of the draining
bronchus is limited to the entry of the cavity. This is probably due to long continued
discharge of tuberculous bacilli from the cavity through the draining bronchus.
5. Theoretically, as to the tuberculous infection of the draining are involved, namely.
Infection by Implantation, Infection by Contiguity, Infection by Lymphatic Spread, and
Infection by Continuity.
According to my study, it is suggested that while the tuberculous change at the entry
of the cavity or cavities probably is due to the direct continuitive infection from the
cavity wall, the solitary tubercule formation in the draining bronchus(especially in the
stump) is due to infection by implantation of the tubercle bacillus
6. In approximately 50% of the patients the roentgenogram revealed the draining band,
and among these draining bands the thickened diffuse from of draining band is
roentgenologically more frequent than the narrow thin form.
7. In eighty-two(82) cases of pulmonary resection for tuberculosis the following
complications developed postoperatively ; bronchfistular in five or 7.3% of the cases,
spread in seven or 8.5% of the cases and long continued bloody sputum in six or 7.3%
of the cases. According to the author's investigation these postoperative complications
were mostly due to tuberculous change in the stump of the draining bronchus.
To avoid these complications, it is advisable to amputate the bronchus as low as
possible in lobectomy or in segmental resection.
8. Some cases of bronchostenosis were caused by collapse therapy for pulmonary
resection was unsatisfactory.
9. The postoperative complications of pulmonary resection for tuberculosis are probably
related to the duration of chemotherapy.
Most cases of postoperative complications occurred in those cases which had received
chemotherapy for less than three months or more than two years. Also recovery from
postoperative complications is more rapid in the case which has received chemotherapy
less than three months compared to the case of long continued chemotherapy
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