Bronchiectasis

Characteristics

  1. Localised irreversible dilatation of bronchi often with thickening of the bronchial wall.
  2. Congenital – structural (bronchial atresia); abnormal mucociliary transport (Kartagener’s); abnormal secretions (cystic fibrosis) or secondary to impaired immune system.
  3. Acquired
  • Post childhood infections.
  • Distal to bronchial obstruction (mucus plug, foreign body, neoplasm).
  • ‘Traction bronchiectasis’ secondary to pulmonary fibrosis.
  1. _ Types of bronchiectasis
  • Cylindrical or tubular (least severe type).
  • Saccular or cystic (most severe type).

Clinical features

  1. Most common presentation is in children.
  2. Increasing breathlessness.
  3. Chronic cough with excess sputum secretion.
  4. Recurrent chest infections with acute clinical exacerbations.

Radiological features

  1. Posterobasal segments of lower lobes most commonly affected.
  2. Bilateral in 50%.
  3. CXR – dilated, thick-walled bronchi giving cystic and tram-lining appearance particularly in the lower lobes. There may be volume loss and overt ‘honeycombing’.
  4. There may be associated areas of infective consolidation and pleuroparenchymal distortion.
  5. HRCT – lack of bronchial wall tapering is the most consistent feature. ‘Signet ring’ sign demonstrating a dilated bronchus adjacent to a smaller normal-calibre artery. The dilated bronchus extends out towards the pleura (<1 cm). Mucus plugging present.

Bronchiectasis

Differential diagnosis

  1. Bronchiectasis may be difficult to appreciate on plain films and even sometimes on CT.
  2. The main differential on plain films and CT lies with the honeycombing seen in advanced pulmonary fibrosis.
  3. On CT, bullous emphysema can mimic cystic bronchiectasis. However, expiratory films confirm air trapping in emphysema and a degree of airway collapse in bronchiectasis.

Management

  1. Regular postural physiotherapy with mucus drainage.
  2. Early use of antibiotics, sometimes with long-term prophylactic regimes.
  3. Bronchodilators may help in acute infective attacks associated with bronchospasm.

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