A case of endotracheal tuberculosis with expectorations of the lateral one-third of the multiple tracheal cartilages is reported. Fibreoptic bronchoscopy revealed caseous materials and loosening of the tracheal cartilages. The patient expectorated cartilaginous material several times before and after fibreoptic bronchoscopy. In spite of the loss of tracheal cartilages, tracheal lumen was maintained with a mild airflow limitation. The remaining two-thirds of the tracheal cartilage rings seemed to be strong enough to support the tracheal lumen opening during the respiratory cycle. Endobronchial tuberculosis is listed as one of the serious complications of pulmonary tuberculosis. Expectoration of bronchial cartilage is extremely rare in endobronchial tuberculosis. Only three previously reported cases have been found [1±3]. Coughing up tracheal cartilages has not been reported before. Such a case is reported in this study. Case reportA 29 yr-old female, with a history of tuberculous lymphadenitis, presented with a severe barking cough and mild dyspnoea. She had noted cough, sputum and mild dyspnoea 2 months prior to visiting our hospital. She had taken some medications without improvement. She noted increasing dyspnoea in the supine position. On questioning, one day before the visit, she had expectorated three or four hard objects during coughing. On physical examination, her vital signs were stable. There was no wheezing or crackling sound during auscultation. Laboratory findings were within normal range. The sputum smear for acid-fast bacilli was positive. The chest radiograph showed faint fibro-streaky densities involving the left upper lobe. The forced vital capacity (FVC) was 2.32 L (63% of predicted), forced expiratory volume at 1 second (FEV1 ) 2.09 L (61% pred), peak inspiratory flow (PIF) 2 L . min -1 . On the flow volume curves, the inspiratory limb had a very flat appearance, which suggests the presence of upper airway obstructive lesions ( fig. 1).Bronchoscopy revealed deep ulcers and two projections of cartilage on the left side of the distal trachea ( fig. 2). Multiple, yellowish mucosal elevations were also noted in the distal trachea. The orifice of the left main bronchus was narrowed with caseous material. After the bronchoscopy, the patient expectorated two tracheal cartilages, which were the lateral one-third part of the tracheal cartilage ( fig. 3). After two weeks of treatment with antituberculosis drugs, the second bronchoscopy showed one small remaining tracheal cartilage with caseous material between the distal trachea and the orifice of the left main bronchus. The remaining small tracheal cartilage was removed by biopsy forceps. After treatment with antituberculosis drugs for 6 months and with corticosteroid for 1 month, the third bronchoscopy was performed. The last bronchoscopy was performed 2 yrs after the initial diagnosis. There were no significant differences between the two periods. The mucosal lesions of tuberculosis were completely healed. There was no progressive tracheal...

Hypertensive patients had smaller indexed aortic root dimensions than normal subjects but they had heigher prevalence of trivial-mild aortic regurgitation in contrast to normotensives who had aortic regurgitation combined with larger aortic diameters.

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