Last revised by Yuranga Weerakkody on 22 Feb 2023

Bronchiectasis (plural: bronchiectases) is defined as an irreversible abnormal dilatation of the bronchial tree. It has a variety of underlying causes, with a common aetiology of chronic inflammation. High-resolution CT is the most accurate modality for diagnosis.

As there are many causes of bronchiectasis, which may occur at essentially any age, no single demographic is particularly involved. Two groups make up the majority of cases: post-infectious and cystic fibrosis 3.

Bronchiectasis typically presents with recurrent chest infections, productive cough more than 8 weeks, production of copious amounts of sputum, and haemoptysis

Bronchiectasis is the common response of bronchi to a combination of inflammation and obstruction/impaired clearance. Causes include 1-7,9,17,21:

A mnemonic to remember common causes is CAPT Kangaroo has Mounier-Kuhn.

According to macroscopic morphology, three types have been described, which also represent a spectrum of severity 8:

According to one study, the relative prevalence of bronchiectatic changes were 14:

  • cylindrical: ~ 47%

  • varicose: ~ 9.9%

  • cystic: ~ 45.1%

  • multiple types: ~ 24.3%

Bronchiectasis can result from the traction of fibrotic lung surrounding an airway. This is known as traction bronchiectasis. There is dilation of bronchi and bronchioles due to elastic tissue and smooth muscle destruction.

When not related to regional fibrotic changes then this is described as non-traction bronchiectasis or free-standing bronchiectasis.

Chest x-rays are usually abnormal but are inadequate in the diagnosis or quantification of bronchiectasis. Tram-track opacities are seen in cylindrical bronchiectasis, and air-fluid levels may be seen in cystic bronchiectasis. Overall there appears to be an increase in bronchovascular markings, and bronchi seen end-on may appear as ring shadows 8. Pulmonary vasculature appears ill-defined, thought to represent peri-bronchovascular fibrosis 8,9.

CT and HRCT especially excel at demonstrating the airways and is able to a greater or lesser degree to distinguish some of the various underlying causes.

A number of features are helpful in diagnosing bronchiectasis 8,9:

  • bronchus visualised within 1 cm of the pleural surface

    • especially true of lung adjacent to costal pleura

    • most helpful sign for early cylindrical change

  • lack of tapering

  • increased bronchoarterial ratio 9

    • diameter of a bronchus should measure approximately 0.65-1.0 times that of the adjacent pulmonary artery branch

    • between 1 and 1.5 may be seen in normal individuals, especially those living at high altitude

    • greater than 1.5 indicates bronchiectasis

A number of ancillary findings are also recognised:

Signs described on CT include:

In general, the treatment of bronchiectasis is medical and involves promoting sputum clearance, using positional physiotherapy, and early and aggressive treatment of pulmonary infections. In some cases, chronic prophylactic administration of antibiotics may be required.

In cases where bronchiectasis is severe and significant morbidity is present, surgical resection of the affected lobe may be of the benefit provided adequate respiratory reserve exists.

In cases where both lungs are extensively involved (e.g. cystic fibrosis) lung transplantation can be considered 10.

The term bronchiectasis is derived from the Greek words bronckos (βρόγχος) meaning airway / loop and ectasis (έκταση) meaning widening.

The differential is in two parts:

  • causes of a particular distribution of bronchiectasis

  • mimics of bronchiectasis

Conditions that may mimic cystic bronchiectasis include 8:

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Cases and figures

  • Figure 1: types of bronchiectasis
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  • Case 1: cylindrical bronchiectasis
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  • Figure 2: gross pathology: bronchiectatic lung
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  • Case 2: showing signet ring sign
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  • Case 3: traction bronchiectasis
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  • Case 4
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  • Case 5: cystic bronchiectasis
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  • Case 6
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  • Case 7: cystic and cylindrical
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  • Case 8: cystic
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  • Case 9
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  • Case 10
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  • Case 11
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  • Case 12: cystic bronchiectasis
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  • Case 13: known case of cystic fibrosis
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  • Case 14: with complicating pneumothorax
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  • Case 15
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  • Case 16: cystic bronchiectasis
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  • Case 17: cystic bronchiectasis
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  • Case 18: cystic bronchiectasis
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  • Case 19: cylindrical due to pulmonary tuberculosis
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  • Case 20: bronchiolitis obliterans
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  • Case 21: post obstructive secondary to endobronchial carcinoid
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