Bronchiectasis

Question 1

bronchiectasis

Answer 1

irreversible airway dilation
focal or diffuse

classic categorization
cylindrical, tubular, varicose, cystic
most common is tubular

Focal bronchiectasis:
changes in a localized area
a consequence of airway obstruction
extrinsic vs. intrinsic

Diffuse bronchiectasis:
wide spread bronchietis
Underlying systemic or infectious disease

etiology
infectious or non-infectious
tuberculosis mycobacteria infection
affects women > 50
cystic fibrosis
late adolescents or early adulthood
mutation cystic fibrosis conductance regulator
leads to infections, inflammation, respiratory failure

Question 2

bronchiectasis causes and risks

Answer 2

vicious cycle hypothesis
susceptibility to infection and poor mucociliary clearence

inflammatory cells
damage airway walls
ongoing inflammatory process
airway obstruction

alpha antitrypsin deficiency
immune-mediated

upper lung field :
post-radiation fibrosis

middle lung field:
iinfection of nontuberculosis mycobacteria
mycobacterium avium complex (MAC)
mycobacterium avium and mycobacterium intracellular

lower lung field :
chronic recurrent aspiration

Question 3

common clinical presentation

Answer 3

shortness of breath, productive cough, and thick, tenacious sputum
crackles and wheezing
clubbing

Mild to moderate obstruction:
Detected on PFT

acute exacerbation:
changes sputum
increase volume and purulence
fever and new infiltrates may not be present

complications :
recurrent infections
microbial resistance
life theating hemoptysis

Question 4

clinical findings

Answer 4

imaging
chest ct
imaging of choice for confirming the diagnosis
airway dilation, lack of bronchial tapering, bronchial wall thicking, and dilated airway
CXR:
lack of sensitivity
presence of tram tracks

Determining infectious cause:
nontuberculous mycobacteria (NTM)
two + sputum cultures or
one bronchial alveolar lavage with positive culture
biopsy with histopathologic features
sputum or pleura fluid culture