Bronchiectasis

Question 1

CT Findings Specific for Bronchiectasis

Answer 1

• airway dilatation (“Tram tracks” or “signet ring Sign”) - a cross sectional area of the airway with a diameter at least 1.5cm times that of the adjacent vessel
• lack of bronchial tapering (including the presence of tubular structures within 1cm from the pleural surface)
• bronchial wall thickening in dilated airways, inspissated secretions (e.g. “Tree-in-bud” pattern)
• cysts emanating from the bronchial wall (especially pronounced in cystic fibrosis )

Question 2

“vicious cycle hypothesis,” in which

Answer 2

susceptibility to infection and poor mucociliary clearance result in microbial colonization of the bronchial tree.

Question 3

Diagnostic criteria for true clinical infection with Nontuberculous Mycobacteria infection (NTM)

Answer 3

• at least 2 sputum samples positive on culture
• at least one broncheoalveolar lavage (BAL) fluid positive on culture
• a biopsy sample displaying histopathologic features of NTM infection (e.g. Granuloma or a positive strain for AFB) along with one positive sputum culture
• pleural fluid sample (or a sample from another sterile extrapulmonary site) positive on culture

Question 4

Recommended regimen for HIV Negative patients with MAC Infection

Answer 4

Macrolide combined with rifampin and ethambutol

Question 5

Treatment for Allergic Bronchopulmonary Aspergillosis

Answer 5

Prolonged course of antifungal - ITRACONAZOLE

Question 6

In one study, the decline of Lung function in patients with non-CF bronchiectasis was similar to that in patients with COPD

Answer 6

With FEV1 declining by 50-55ml per year as opposed to 20-30mL per year for healthy controls

Question 7

Etiology that often preferentially affects the midlung fields

Answer 7

Mycobacterium avium intracellulare complex

Dyskinetic/immotile cilia syndrome

Question 8

Etiology that preferentially affect the central lung fields

Answer 8

Allergic Bronchopulmonary Aspergillosis
Mounier Kuhn Syndrome
Williams Campbell Syndrome

Question 9

Perecentage of idiopathic cases of bronchiectasis

Answer 9

25-50%

Question 10

MOA of Itraconazole

Answer 10

Interferes with cytochrome P450 activity, decreasing ergosterol synthesis (principal sterol in fungal cell membrane) and inhibiting cell membrane formation