General Presentation of Bronchiectasis with many radiographic illustrations

2. BRONCHIECTASIS
UMA CHIDIEBERE JOHN

3. Definition
Irreversible dilatation of the cartilage containing airways.

5. Types of bronchiectasis
Types of
bronchiectasis
Cylindrical Varicose Cystic

6. Cylindrical
bronchiectasis
Varicose
bronchiectasis
Cystic
bronchiectasis
Mild Moderate Sever
Tram track
appearance
String of beads Cluster of grapes

7. Cylindrical bronchiectasis

8. Varicose bronchiectasis

9. Cystic bronchiectasis

10. •Etiology
Post infection
Infection:
Bacterial, mycobacterial, esp. ABPA central airway bronchiectasis
Airway obstruction:
intraluminal tumor, foreign body, lymph nodes, COPD
Immunodeficiency:
ciliary dyskinesia, HIV, hypogammaglobulinemia, cystic fibrosis (obstruction and immunodef.)

13. CLINICAL MANIFESTATIONS
Persistent or recurrent cough with purulent sputum.
Hemoptysis
Initiating episode: Severe pneumonia, or insidious onset of
symptoms or asymptomatic or non-productive cough – dry
bronchiectasis in upper lobe,
Dyspnea, wheezing – widespread bronchiectasis or underlying
COPD.
Exacerbation of infection: Sputum volume increase, purulence
or blood.

14. PHYSICAL EXAMINATION
Any combination of rhonchi, crepitations or wheezes.
Clubbing of digits.
Chronic hypoxemia  cor pulmonale  R heart failure
Amyloidosis (rare)

15. DIAGNOSIS - 1
Clinical
Radiology: Chest XR: May be non-specific
mild disease – normal XRC
advanced disease – cysts + fluid levels
peribronchial thickening, “tram tracks”, “ring shadows”
CT Scan: Peribronchial thickening, dilated bronchioles.
Sputum culture: Pseudomonas aeruginosa, H.influenzae.

16. DIAGNOSIS - 2
Lung function: Airflow obstruction – FEV1 decreased.
Air trapping - RV increased
Sweat test – increased sodium and chloride in cystic fibrosis
Bronchoscopy: Obstruction – foreign body, tumor.
Immunoglobulin
Cilia function and structure – Kartagener syndrome.

17. Plain radiographic signs of bronchiectasis
•In most cases.Normal
•Tram track shadows
•Signet ring shadows
Specific
findings of
bronchial
dilatation
• Peribronchial cuffing (thickened hazy bronchial wall).
• Finger in glove opacities (mucus filled bronchi).
• Multiple air fluid levels (fluid filled bronchi).
Non
specific
findings

19. Mucoid impaction

20. Fluid filled bronchi

21. CT signs of bronchiectasis
•Signet ring sign (broncho-arterial ratio>1).
•Lack of bronchial tapering.
•Abnormal bronchial contour.
•Visibility of peripheral air ways.
Specific
findings of
bronchial
dilatation
• Peribronchial cuffing (thickened hazy bronchial wall).
• Finger in glove opacities (mucus filled bronchi).
• Multiple air fluid levels (fluid filled bronchi).
Non
specific
findings
• Mosaic perfusion.
• Air trapping.
• Tree in bud opacities.
Ancillary
findings of
small air
way disease

22. •Signet ring sign (broncho-arterial ratio > 1).
•Lack of bronchial tapering.
•Abnormal bronchial contour.
•Visibility of peripheral air ways.
Specific
findings
of
bronchial
dilatation

23. Signet ring sign
broncho-arterial ratio > 1

24. Normal bronchus Lack of bronchial tapering

25. Abnormal bronchial contour

26. Visibility of peripheral air ways within 1cm
from the costal pleura

28. • Peribronchial cuffing (thickened hazy bronchial
wall).
• Finger in glove opacities (mucus filled bronchi).
• Multiple air fluid levels (fluid filled bronchi).
Non
specific
findings

29. Bronchial wall thickening

30. Mucoid impaction

31. Multiple air fluid levels

33. • Mosaic perfusion.
• Air trapping.
• Tree in bud opacities.
Ancillary
findings
of small
air way
disease

34. Mosaic perfusion

35. Air trapping

36. Tree in bud opacities

37. Pseudo-bronchiectasis
Pitfalls in diagnosis of bronchiectasis.
Motion artifact (respiratory or cardiac motion artifact).

39. DD of
bronchiectasis
Localized Diffuse

40. Localized
bronchiectasis
Luminal
Endobronchial
tumor
Bronchilithiasis
F.B
Mural
Atresia Stenosis
Extramural
Extrinsic
compression
Traction
bronchiectasis

41. Diffuse
bronchiectasis
Central
predominance
ABPA
Mounier Kuhn S
William Campbell S
Upper lobe
predominance
Cystic fibrosis
Sarcoidosis
Middle lobe
predominance
Mycobacterial infection
Immotile cilia syndrome
Lower lobe
predominance
Idiopathic (40%)
Recurrent childhood
infection
Repeated aspiration
Interstitial lung disease

42. Diffuse bronchiectasis
with upper lobe predominance
Cystic fibrosis.
Sarcoidosis.

43. Cystic fibrosis

44. Diffuse bronchiectasis
with middle lobe & lingula predominance
Non tuberculous mycobacterial infection.
Immobile cilia syndrome.

45. Mycobacterium avium intercellulare infection

46. Immotile cilia syndrome

47. Bronchiectasis
with lower lobe predominance
1. Idiopathic (40% of cases).
2. Recurrent childhood infection.
3. Repeated aspiration.
4. Interstitial lung disease.

48. TREATMENT - 1
4 Goals: 1. Eliminate cause
2. Improve tracheo bronchial
clearance
3. Control infection
4. Reverse airflow obstruction

49. TREATMENT - 2
1. Immunoglobulin
2. Antituberculous drugs
3. Corticosteroids (ABPA)
4. Remove aspirated material
Chest physical therapy
Mucolytics
Bronchodilators

50. TREATMENT - 3
Antibiotics – short course, prolonged course, intermittent regular
courses, inhalation.
Initial empiric Rx: Ampi, Amox, Cefaclor, Septran
Ps.aeruginosa – Quinolone, aminoglycoside, 3rd generation
cephalosporin, pipracillin.
Surgery:
Oxygen and diuretics
Lung transplant