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Bronchiectasis

 

• Pathologic dilation of the medium sized airways

• Proximal bronchiectasis is characteristic of allergic bronchopulmonary aspergillosis (ABPA)

• Classical clinical triad: chronic cough, excess sputum production and repeated infection

Pathogenesis

            • Three major causes are: obstruction, infection and traction

            • Bronchiectasis is common when there is prolonged partial obstruction, e.g. slow-growing neoplasms, foreign bodies

            • Infection is most important cause of bronchiectasis

            • Bronchial wall destruction occurs in infection

            • Traction comes from a force, usually due to increased elastic recoil in the surrounding lung, which pulls the bronchus and dilates it

Location        

            • Bronchiectasis from viral or pyogenic infections is usually at the bases

            • Tuberculous bronchiectasis is usually at the apices

            • Diffuse bronchiectasis

                        § Impaired mucus clearing e.g. cystic fibrosis and Kartegeners

                        § ABPA

                        § Chronic diffuse airways disease (chronic bronchitis, asthma, bronchiolitis obliterans

                        § Immune deficiency states

X-ray

            • “Tramlines” or “honeycombing” represents dilated, thickened bronchial walls

            • Volume loss due to destruction of lung tissue

            • Multiple small nodular densities from plugged alveoli

            • Signet ring appearance on CT: normally, the vessel is larger than the corresponding bronchus. In bronchiectasis, the bronchus is larger than the corresponding vessel

            • Lack of bronchial tapering

            • Non uniform bronchial dilation

            • Bronchial wall thickening

WH/’92

 

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