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Bronchoscopic Myths and Legends: Bronchoscopy in the Diagnosis of Pulmonary Tuberculosis

The diagnosis of suspected pulmonary tuberculosis in patients who are either unable to produce sputum spontaneously or who have expectorated sputum that is smear-negative for acid fast bacilli is difficult. Bronchoscopy is often considered in these cases, but its use varies. We reviewed the existing literature to determine if bronchoscopy with bronchoalveolar lavage is superior to evaluation of induced sputum samples in these patients and to see if the addition of transbronchial biopsy improves the usefulness of bronchoscopy in this setting. We provide recommendations on the timing and appropriateness of bronchoscopy in this setting.