Bronchial anthracofibrosis

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Bronchial anthracofibrosis is defined as luminal bronchial narrowing associated with anthracotic pigmentation on bronchoscopy, without a relevant history of pneumoconiosis or smoking.

Epidemiology

There is a preponderance for bronchial anthracofibrosis affecting women in their sixties.

Risk factors

Exposure to biomass fuel smoke  is a risk factor. There is also a potential relationship between bronchial anthracofibrosis and tuberculosis . Co-existence of tuberculosis and anthracofibrosis is high (~50%), and the CT findings are similar for the two conditions .

Clinical presentation

Chronic productive cough, dyspnea, hemoptysis, chest pain, fever and general weakness .

Pulmonary functional tests show an obstructive pattern in 50% of the patients affected, with small airway dysfunction varying according to the severity of bronchial stenosis.

Radiographic features

Plain radiograph

Chest x-ray findings are non-specific :

CT
  • segmental collapse distal to the involved bronchi
    • right middle lobe is the most frequently involved
  • enlarged mediastinal or hilar lymph nodes adjacent to the involved bronchi or calcified nodes adjacent to the bronchi
  • bronchial narrowing accompanied by thickening of the wall or peribronchial cuffing
  • other findings: fibrotic bands, nodules, bronchiectasis

Differential diagnosis