Bronchoscopic manifestations and epidemiological characteristics of lymph node fistula-type tracheobronchial tuberculosis in Hunan Province, China (2019–2023)

This study aimed to investigate the epidemiological characteristics, clinical features, bronchoscopic manifestations, and imaging findings of lymph node fistula-type tracheobronchial tuberculosis (TBTB) in Hunan Province, China, from 2019 to 2023, to provide insights for improved diagnosis and management. A retrospective analysis was conducted on 933 hospitalized cases of lymph node fistula-type TBTB in the rupture stage, identified from the bronchoscopy electronic medical record system at Hunan Chest Hospital. Patients were stratified into elderly and non-elderly groups. Comparative analyses were performed on demographics, clinical symptoms, laboratory parameters, bronchoscopic subtypes, pathogen detection, and imaging findings. Patients were stratified into elderly (≥ 60 years, n = 424) and non-elderly (< 60 years, n = 509) groups. The mean patient age was 53.30 ± 18.42 years, with males slightly outnumbering females (52.09% vs. 47.91%). Elderly patients exhibited a male predominance (male-to-female ratio of 1.62:1), whereas the non-elderly group had a female predominance (male-to-female ratio of 0.57:1). Laboratory findings revealed lower hemoglobin and albumin levels but higher erythrocyte sedimentation rates (ESR) in elderly patients (P < 0.05 for all comparisons). Bronchoscopic examination identified ulcerative-perforative (47.91%) and granulomatous-proliferative (43.84%) as the most common fistula subtypes, with the former predominating in elderly patients (80.66%) and the latter in non-elderly patients (70.14%). Pathogen detection rates were higher in BALF samples (67.52%) than in sputum samples (57.88%), with elderly patients exhibiting higher positivity rates (P < 0.05). Chest CT showed mediastinal or hilar lymphadenopathy in 72.78% of cases, with partial calcification more common in elderly patients. Correlation analysis revealed that ulcerative-perforative subtypes were associated with older age, female sex, longer symptom duration, and higher ESR, while granulomatous-proliferative subtypes were linked to younger age, male sex, and better nutritional status. Lymph node fistula-type tracheobronchial tuberculosis (TBTB) is prevalent in elderly females, who are susceptible to severe ulcerative-perforative lesions closely associated with caseous necrosis and prolonged inflammation. Conversely, younger males mostly present with granulomatous-proliferative subtypes, suggestive of milder inflammation. Bronchoscopy and BALF testing are critical for subtype-specific diagnosis, and tailored management strategies are key to improving patient outcomes. Not applicable.