Bronchiectasis

From Anvita Health Wiki

Contents 1 Introduction 2 Etiology 3 Pathology 4 Clinical-manifestations 5 Laboratory 6 Diagnostic-procedures 7 Radiology 8 Complications 9 Management 10 More General Terms 11 Additional Terms 12 References

Introduction

• Chronic dilation of bronchi or bronchioles as a sequel of inflammatory disease or obstruction.

Etiology

• infection

• pneumonia (reversible cause)
• chronic bronchitis (reversible cause)
• organisms

• bacterial

• tuberculosis (especially affecting upper lobes)
• pertussis in children

• viral

• adenovirus in adults
• measles or influenza in children

• fungal (chronic mycoses) (affects upper lobes)

• histoplasmosis
• coccidioidomycosis

• ciliary dyskinesia ( immotile cilia syndrome)

• inherited
• acquired (especially smoking)

• immunoglobulin disorders

• Bruton's agammaglobulinemia
• selective IgA deficiency
• hyperimmunoglobulin E ( Job's syndrome)

• right middle lobe syndrome
• allergic bronchopulmonary aspergillosis

• affects upper lobes
• reversible cause

• yellow nail syndrome
• Young's syndrome
• unilateral hyperlucent lung syndrome
• cystic fibrosis (affects upper lobes)
• uncommon causes

• alpha-1 antitrypsin deficiency
• rheumatoid arthritis ( Felty's syndrome)
• toxic inhalation
• chronic tracheobronchial stenosis
• recurrent aspiration
• heroin
• inflammatory bowel disease
• foreign body
• sequestrated lung
• chronic tracheoesophageal fistula
• heart- lung transplantation
• chronic granulomatous disease
• neoplasms

Pathology

• most commonly occurs in lower lung fields
• in most cases 2nd to 4th order bronchi are involved
• bilateral involvement in 30%

Clinical-manifestations

• chronic productive cough
• sputum

• purulent
• frequently copious
• may be foul smelling ( fetor oris)

• recurrent bronchial infection
• sinusitis may be present
• hemoptysis may occur (especially in areas of old tuberculosis)
• coarse rales at lung bases
• clubbing of fingers
• arthralgia
• hypertrophic pulmonary osteoarthropathy
• anorexia & weight loss

Laboratory

• sputum cultures yield a mixture of organisms
• sputum forms layers on standing
• serum IgA, serum IgG, serum IgM

Diagnostic-procedures

• pulmonary function testing:

• generally shows obstructive lung disease

• bronchoscopy to identify obstruction

Radiology

• chest X-ray

• may appear normal even with advanced disease
• patches of increased density at lung bases
• crowding of bronchi
• segmental atelectasis
• honeycombing with cystic spaces measuring < 2.0 cm
• loss of lung volume
• air-fluid level (if cystic bronchiectasis is present)
• 'tram lines' from inciting event, i.e. pneumonia in childhood

• computed tomography ( CT) of thorax has replaced bronchography as the diagnostic modality of choice

• signet-ring shadows

• dilated bronchus (ring) with bronchial artery ( stone)

• bronchial wall thickening
• dilated bronchi extending to the periphery
• bronchial obstruction secondary to inspissated purulent secretions
• loss of lung volume
• air-fluid level (if cystic bronchiectasis is present)

Complications

• severe hemoptysis
• progressive respiratory failure with hypoxemia
• cor pulmonale
• secondary infection

• generally saprophytic infection with fungi &/or mycobacteria
• Pseudomonas aeruginosa

• most commonly isolated organism
• impossible to erradicate
• infection with Pseudomonas correlates with more extensive disease

Management

• treatment aimed at controlling symptoms

• postural drainage
• chest physiotherapy
• humidification
• bronchodilators
• cyclic antibiotic therapy

• treat underlying disorders aggressively
• surgery

More General Terms

• chronic lung disease

Additional Terms

• allergic bronchopulmonary aspergillosis (ABPA)
• Bruton type agammaglobulinemia
• ciliary dyskinesia; immotile cilia syndrome (Kartagener's syndrome)
• hyperimmunoglobulin E (Job's syndrome)
• right middle lobe syndrome
• selective IgA deficiency
• yellow nail syndrome (lymphedema & yellow nails)
• Young's syndrome (obstructive azoospermia)

References

1. Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
2. Guide to Physical Examination & History Taking, 4th edition, Bates B, JB Lippincott, Philadelphia, 1987
3. DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 870
4. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 746-48
5. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, American College of Physicians, Philadelphia 1998, 2006

bronchiectasis