Bronchiectasis

Question 1

Permanent dilation of bronchi and bronchiole

Answer 1

Bronchiectasis

Question 2

List the predisposing factors/ aetiology of bronchiectasis

Answer 2

Congenital / hereditary conditions that predispose to chronic infections (e.g. cystic fibrosis, immunodeficiencies);
Severe necrotizing pneumonia;
Bronchial obstruction (e.g. tumour, foreign body, mucus impaction);
Immune disorders (e.g. rheumatoid arthritis);
Idiopathic (50% of cases; likely due to dysfunctional host immunity to infectious agents, causing chronic inflammation)

Question 3

Explain how obstruction leads to bronchiectasis

Answer 3

obstruction +distal airway distention mediated by ongoing inflammation and airway destruction
Results in impaired with drainage of secretions and infection (the latter is usually the result of a defect in airway clearance e.g. obstruction).

Question 4

Explain how the cystic fibrosis leads to bronchiectasis

Answer 4

Cystic fibrosis: thick viscous secretions lead to airway obstruction, which predisposes to chronic bacterial infections. The infections cause widespread damage to airway walls, resulting in markedly dilated bronchi and progressive fibrous obliteration of smaller bronchioles (bronchiolitis obliterans)

Question 5

Explain how the primary ciliary dyskinesia leads to bronchiectasis

Answer 5

Primary ciliary dyskinesia:EG with Kartagener syndrome. ciliary dysfunction again prevents mucociliary clearance and predisposes to recurrent infections that lead to bronchiectasis

Question 6

explain how the allergic bronchopulmonary aspergillosis caused bronchiectasis

Answer 6

Allergic bronchopulmonary aspergillosis: hyperimmune response to Aspergillus fumigatus that occurs in patients with asthma or cystic fibrosis and results in mucus plug formation, leading to development of bronchiectasis

Question 7

list 3 clinical findings of bronchiectasis

Answer 7

Episodes of severe persistent productive cough with foul-smelling +/- bloody sputum,

Dyspnoea and orthopnoea, and possibly haemoptysis that can be massive;

Upper respiratory tract infections or introduction of new pathogenic agents

Question 8

explain the complications of bronchiectasis

Answer 8

1. Cor pulmonale
2. Hematogenous spread of infection (brain abscesses)
3. Secondary amyloidosis

Question 9

Explain the gross appearance of bronchiectasis

Answer 9

Look for background chronic disease

Diffuse or localised destruction and dilatation of distal bronchi and bronchioles

Back to back crowding of dilated airways , with minimal intervening fibrosis and aerated lung parenchyma

Localized disease usually associated with obstruction by tumour / foreign bodies

Usually lower lobes,

Starts in hilar region extends to involve length of airway up to the pleural surfaces

Airways filled with mucopurulent secretions,

Question 10

Microscopic appearance of bronchiectasis depends in what?

Answer 10

Depends on the activity/ chronicity of disease

Question 11

explain the active microscopic appearance of bronchiectasis

Answer 11

1. Intense acute and chronic inflammation in the walls of bronchi and bronchioles
2. Associated with ulceratio, squamous metaplasia +/- lung abscess formation

Question 12

Explain the microscopic chronic appearance of bronchiectasis

Answer 12

Fibrosis of the bronchial/bronchiole walls
Peribronchiolar fibrosis, results lumen obliteration

Question 13

Bronchiectasis usually affect which lobes of the lungs

Answer 13

Lower lobes

Question 14

The airways become filled with what?

Answer 14

Mucopurulent secretion

Question 15

Bronchiectasis starts where?

Answer 15

Starts in hilar region extends to involve length airway up to the pleural surfaces