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CT and MRI appearance of a fistula between the right and left main bronchus caused by tracheobronchial tuberculosis

Departments of ¹Radiology and ²Respiratory Medicine, Dokuz Eylül University Hospital, zmir, 35340, Turkey

View larger version (161K): [in a new window]   Figure 1. CT with coronal reformatting of the airways shows an air-containing connection (black arrowhead) between the proximal main bronchi, with mild luminal narrowing adjacent to the involved bronchi. Note the position of the carina (open arrow).

View larger version (41K): [in a new window]   Figure 2. (a) Coronal and (b) axial T1 weighted MR images show a fistulous tract (white arrow) just below the carina (open arrow). Note the uneven mural thickening of the airways through the distal trachea and proximal main bronchi (arrowheads).

View larger version (65K): [in a new window]   Figure 3. (a) Bronchoscopy shows widespread ulceration of the tracheobronchial mucosa and a yellow lesion with caseating material adjacent to the opening site of the right main lobe bronchus. A fistula (arrow) extending from the left main bronchus towards the right main bronchus (asterisk) is also seen. (b) Photomicrograph of the bronchial brushing material with acid-fast staining shows Mycobacterium tuberculosis bacilli (arrowheads) (Ziehl–Neelsen stain, x 100).