Bronchiectasis - Summary What? • Bronchiectasis is derived from the Greek words bronckos meaning airway and ectasis meaning widening. • Permanent irreversible dilatation of cartilage containing airways. Why? Due to: • Recurrent infection or inflammation • Impaired mucociliary clearance • Chronic inflammation causes irreversible bronchial wall injury → mucous stasis → perpetuating airway obstruction and inflammation Symptoms: • Chronic cough • Hypoxia • Dyspnea • Hemoptysis • Coughing up yellow or green mucus daily • Fatigue, feeling run-down or tired • Fevers and/or chills • Wheezing • Clubbing of nails • Loss of weight • Chest pain/tightness Most Common Causes: • Cystic fibrosis • Aspiration • Immunodeficiencies • Connective tissue diseases • Airway obstruction • COPD • Congenital • Mounier-Kuhn syndrome (congenital tracheobronchomegaly) • Hypersensitivity: ABPA • Infection: TB, NTM, PNA • Primary ciliary dyskinesia • Young syndrome (bronchiectasis, sinusitis, and obstructive azoospermia and no evidence of cystic fibrosis) Physical Examination: • Crackles, rhonchi, scattered wheezing, and inspiratory squeaks on auscultation • Digital clubbing (2-3% of patients; more frequent in moderate-to-severe cases) • Cyanosis and plethora with polycythemia from chronic hypoxia • Wasting and weight loss • Nasal polyps and signs of chronic sinusitis • Physical stigmata of cor pulmonale, in advanced disease Complications: • Superimposed infection - increase in the peribronchial thickening, presence of air-fluid levels, centrilobular nodules, or consolidation in the adjacent lung parenchyma. • Pulmonary artery hypertension • Mosaic attenuation • Volume loss of the affected lung parenchyma Diagnosis: • HRCT (high-resolution chest CT) • Broncho-arterial ratio (BAR) - BAR >1.0 is abnormal in adults • Blood tests and sputum cultures (sputum for bacteria and Acid fast) • Pulmonary function tests: obstructive • Bronchoscopy Laboratory: • ANA, RF, CCP, ANCA • HIV, Immunoglobulins (Ig M, A, G, E) • Sweat chloride test, α1-antitrypsin deficiency Sputum cultures growing uncommon pathogens: • Pseudomonas aeruginosa • Aspergillus • Nontuberculous mycobacteria Treatment: • Clearing the airway • Treating infections • Preventing exacerbations #Bronchiectasis #pulmonary #differential #diagnosis
