Bronchiectasis (summary)

Last revised by Jeremy Jones on 9 May 2018
This is a basic article for medical students and other non-radiologists

Bronchiectasis refers to permanent dilatation of the airways secondary to chronic inflammation or infection. It is the common pathological response of bronchi to a variety of congenital and acquired conditions.

Reference article

This is a summary article; read more in our article on bronchiectasis.

  • epidemiology
    • ​​more prevalent in females and older age groups
      • 60% of UK diagnoses made in patients over 70
    • triggering disease may be congenital or acquired
  • presentation
    • chronic productive cough with thick, foul-smelling sputum
    • recurrent chest infections
    • hemoptysis 
    • shortness of breath
    • wheeze
    • examination findings:
      • general - clubbing (rare)
      • auscultation - coarse crackles, scattered wheeze
  • pathogenesis
    • a combination of chronic inflammation/infection and impaired bronchial clearance damages the airways
    • progressive destruction of lung tissues
      • widened airways with scarred and thickened walls
      • trapped mucus harbors pathogens
  • etiology
  • investigation
    • chest x-ray
    • high-resolution CT
    • sputum culture (esp. during exacerbation)
    • pulmonary function tests (reduced FEV1)
    • specific tests to investigate cause
      • e.g. sweat sodium measurement (CF) or immunoglobulins
  • treatment
    • goals are to prevent infections and control complications
    • conservative
      • smoking cessation
      • respiratory physiotherapy and postural drainage
      • pneumococcal vaccine, annual influenza vaccine
    • medical
      • prompt antibiotic treatment for exacerbations
        • long-term prophylactic antibiotics may be required in patients with frequent recurrences
      • bronchodilator therapy
        • beta agonists and inhaled corticosteroids
    • surgical
      • only for a small minority of patients with localized disease

Chest x-rays are usually insufficient in the diagnosis and management of bronchiectasis. May be normal or may show dilated bronchi with thickened walls (tram-track sign). An air-fluid level may be seen in severe cystic bronchiectasis.

High-resolution CT is the gold standard for diagnosis. Provides a better visualization of the classical airway dilatation and bronchial wall thickening (tram-track) in bronchiectasis. Enlarged airways display a signet-ring sign in cross-section with their accompanying pulmonary artery. Cysts may also be visualized.

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