目的探讨胸片正常的支气管内膜结核(EBTB)的临床特征和临床诊断。方法回顾性分析41例胸片正常的EBTB患者的临床特征和纤维支气管镜(纤支镜)检查。结果本组EBTB患者主要症状有:咳嗽(34例),胸闷气促(12例),咯血(9例),发热(5例),盗汗(4例)。≤35岁组患者25例,其中2例合并有其他慢性疾病,病程平均为(5±4)个月;>55岁组患者7例,有5例合并有其他慢性疾病,病程平均为(10±6)个月,两组比较差异有统计学意义(P<0.01)。纤支镜检查见充血水肿型16例,活动性干酪样坏死型11例,肉芽肿型7例,肿瘤样型2例,溃疡型4例,非特异性支气管型5例,纤维性狭窄型1例。镜下活检病理确诊26例,刷检涂片检查阳性18例,镜下吸引的分泌物或灌洗液抗酸杆菌检查阳性13例。镜检前痰涂片11例阳性,镜检后涂片19例阳性。结论胸片显示正常的EBTB缺乏特异的临床表现,有慢性咳嗽的患者以及合并有糖尿病或其他呼吸系统慢性疾病的老年患者都应警惕EBTB可能。确诊主要依靠纤支镜检查。 Objective To investigate the clinical features and clinical diagnosis of bronchial endocardial tuberculosis (EBTB) with normal chest radiograph. Methods The clinical features and fiberoptic bronchoscopy of 41 patients with normal chest radiographs were retrospectively analyzed. Results The main symptoms of EBTB patients were cough (34 cases), chest tightness and shortness of breath (12 cases), hemoptysis (9 cases), fever (5 cases) and night sweats (4 cases). There were 25 patients in the group of 35 years old or older, of whom 2 had other chronic diseases with an average duration of (5 ± 4) months; 7 patients aged 55 years and 5 with other chronic diseases with an average of 10 ± 6) months, the difference between the two groups was statistically significant (P <0.01). Bronchoscopy showed congestion and edema in 16 cases, active caseous necrosis in 11 cases, granulomatous in 7 cases, tumor-like in 2 cases, 4 cases of ulceration, non-specific bronchial in 5 cases, 1 case of fibrous stenosis . Microscope biopsy pathology confirmed in 26 cases, brush test smear positive in 18 cases, under the microscope to attract the secretions or lavage fluid acid-fast bacilli positive in 13 cases. 11 cases of positive sputum smear before microscopy, 19 cases of positive smear after microscopy. Conclusions Chest radiographs indicate that normal EBTB lacks specific clinical features. EBTB should be considered as a possible risk for patients with chronic cough and elderly patients with diabetes or other chronic diseases of the respiratory system. The main diagnosis depends on bronchoscopy.