Bronchiectasis Notes PDF

# Bronchiectasis MBBS.weebly.com ## Overview - Definition - Etiology - Pathology - Clinical Presentation - Diagnosis & Differential Diagnosis - Treatment ## Definition Bronchiectasis is a condition anatomically defined by chronic, irreversible dilation and distortion of the bronchi caused by inflamm...

# Bronchiectasis MBBS.weebly.com ## Overview - Definition - Etiology - Pathology - Clinical Presentation - Diagnosis & Differential Diagnosis - Treatment ## Definition Bronchiectasis is a condition anatomically defined by chronic, irreversible dilation and distortion of the bronchi caused by inflammatory destruction of the muscular and elastic components of the bronchial walls. ## Etiology ### Conditions Associated with the Development of Bronchiectasis 1. Postinfection - Bacterial pneumonia - Tuberculosis - Pertussis - Measles - Influenza 2. Proximal Airway Obstruction - Foreign body aspiration - Benign airway tumors - Middle lobe syndrome - Extrinsic compression by enlarged lymph nodes of the right middle lobe of the lung that obstructed bronchi and lead to right middle lobe atelectasis and recurrent infection. ### Diagram of the Trachea and Bronchi An illustration depicts the trachea and branching into two bronchi, with the following labels: - Cartilaça thyroidea - Cartilago or coidea - Trachea - Cartilagines tracheales - Bra ### Endoscopic Image An image shows an endoscope view of the interior of a bronchus. 3. Abnormal Host Defense - Ciliary dyskinesia (Kartagener's syndrome) - Humoral immunodeficiency 4. Genetic Disorders - Cystic fibrosis - α1 - Antitrypsin deficiency 5. Others ## Pathology - Dilation and distortion of the bronchi - Damage of airway epithelium - Dilation and hyperplasia of blood capillary ### Images of Lung Tissue An image shows a cross-section of a lung with noticeable bronchiectasis, where the bronchi have abnormally dilated and distorted. An image shows another cross-section of a lung with bronchiectasis. ## Clinical Presentation ### Symptoms The production of large quantities of purulent and often foul-smelling sputum. The volume of sputum can be used for estimating the severity of the disease: - Mild: < 10 mL - Moderate: 10-150 mL - Severe: >150 mL - Dry bronchiectasis usually involve the upper lobes ### Other Symptoms - Chronic cough - Hemoptysis: - Frequent - More commonly in dry variety - Usually mild (blood streaking of purulent sputum) - Massive hemoptysis is usually from dilated bronchial arteries or bronchial-pulmonary anastomoses under systemic pressure - Recurrent pneumonia: same segment - Systemic manifestations: fever, weight loss ### Physical Finding - Early phases or dry variety: normal - Severe or secondary infection: persisting crackling rales in the same part of lung - Later stage: digital clubbing, emphysema, and cor pulmonale. ## Evaluation ### Roentgenographic Studies 1. The plain chest film: increased in size and number of bronchovascular markings (quiet nonspecific) 2. Bronchography: (traditional gold standard) ### Images of Chest X-rays An image shows a chest x-ray of a patient with bronchiectasis. An image shows a bronchographic image of the lungs. ### Computed Tomography (CT) - CT or HRCT: high sensitivity and specificity - Train track sign: the bronchial wall is thickened and visible; the bronchi lose the trend of narrowing from proximal end to distal end. - Diamond ring sign: dilated bronchi appear as ring structures with internal diameters greater than those of their accompany pulmonary artery branches. ### Images of CT Scans An image shows chest x-ray, HRCT scan, and HRCT scan showing bronchiectasis, respectively. - 30-year-old female with cough and sputum production. Radiograph shows linear densities (A). HRCT scan (middle) taken in the same area shows severe bronchiectasis. HRCT scan (left) demonstrates abnormal bronchi that are not identified on the plain film (B). An image shows a CT scan showing bronchiectasis in the right lung. ### Bronchoscopy - Evaluating the proximal airways for lesions. - Assessing the cause of hemoptysis. - Localizing the source of hemoptysis ### Image of Bronchoscopy An image shows a bronchoscopy view of the bronchi with mucus buildup. ## Diagnosis - Symptoms - Sign - Roentgenographic finding ## Differential Diagnosis ### Differentiate From: - Chronic bronchitis: No recurrent hemoptysis; CT scan - Lung abscess: X-ray/CT: local infiltrated shadow or cavitations with air-fluid level inside. - Tuberculosis: radiographic finding; sputum anti-fast smear - Congenital pulmonary cyst: multi thin wall cavities without infiltration around. ## Treatment ### Medical Management 1. Improving the drainage of airway - Expectorant - Bronchodilators - Postural drainage - Bronchoscopy ### Images of Postural Drainage Positions - An animated illustration shows the “right and left superior lobe anterior segment” posture. - An animated illustration shows the “right superior lobe posterior segment” posture. - An animated illustration shows the “right and left inferior lobe dorsal segment” posture. ### Medical Management 2. Antibiotic - The choice of antibiotics should be accurately by the results of sputum culture and drug sensitivity test. - Empirical therapy -- antipseudomonal antibiotics. ### Surgical Therapy 2. Recurrent and refractory clinical symptoms are due to a focal area of disease involvement. 3. Massive hemoptysis - Management of hemoptysis ### Thank You An image shows a lake and trees covered in snow. The text “THANK YOU” is in dark green in the middle of the image.