BRONCHIACTASIS

Disease characterize by irreversible abnormal dilatation of the bronchial tree.

Causes

Cystic fibrosis

Cilliary dyskinesia

Immune deficiencies ( predispose to infections)

Post infectous ( pertusis, measles, TB )

Congenital (willian cambel syndrome – absence of anular bronchial cartilage, Marner kahn syndrome- congenital trecheo bronchio megally.)

Pathogenesis

Bronchial obstruction ( by FB, mucus due to poor mucus clearing)

Infections

Chronic inflammation

Difficulty in clearing secretions and recurrent infections

Pathologic forms

Cylindrical bronchiactasis	Varicose bronchiactasis	Secular (cystic) bronchiactasis
Diffuse dilatation of bronchial unit. Bronchial outlines are regular Bronchial lumen ends abruptly due to mucus plugging Tram lines, signet ring appearance	Greater degree of dilatation and local constrictions. Irregular outlines resembling varicose veins May have small secualtions Beaded contour	Bronchial dilatation progresses resulting in ballooning of bronchi and this ends up in fluid or mucus sacs Strings and clusters

Clinical features

History

Cough with copious, purulent and foul smelling sputum.

Heamoptysis

Fever during exacerbations

Anorexia and weight loss

Wheezing

If sever dypnea and hypoxia

Physical Examination

Finger clubbing

Localized crepitations

Investigations

v Sputum C/S

v CXR:

- Increase size and loss of bronchovascular markings

- Crowding of bronchi

- Loss of lung volume

- Cystic spaces

- Airfluid levels

- Honey comb appearance

- Compensatory hyperinflation of the unaffected lungs

v Bronchoscopy

v CT chest (gold standard)

- Location

- Presence of mediastinal lesions

- Extent of segmental involvement

The CT findings in patients with bronchiectasis typically include cylindrical (“tram lines,” “signet ring appearance”), varicose (bronchi with “beaded contour”), cystic (cysts in “strings and clusters”), or mixed forms.

Treatment

Chest physiotherapy

Reduce airway obstruction

Control infections