Bronchiectasis

Question 1

What is bronchiectasis?

Answer 1

Irreversible dilatation of airways resulting from inflammatory destruction of airway walls due to chronically infected mucous.

Question 2

Where does bronchiectasis usually affect?

Answer 2

Medium sized airways

Question 3

Common pathogens in bronchiectasis?

Answer 3

P. aeruginosa most common.

Also S. aureus, H. influenzae

Question 4

What is the broad aetiology of bronchiectasis?

Answer 4

1. Obstruction
2. Post infection
3. Impaired defences

Question 5

What are the obstructive causes of bronchiectasis?

Answer 5

• Tumour
• Foreign body
• Thick mucous

Question 6

Which infections may produce post-infectious bronchiectasis?

Answer 6

• Pneumonia
• TB
• Measles
• Pertussis
• ABPA
• MAC (mycobacterium avium complex)

Question 7

How do impaired defences precipitate bronchiectasis?

Answer 7

Leads to interference of drainage, chronic infections and inflammation.

Question 8

Examples of impaired defences which may precipitate bronchiectasis?

Answer 8

• Hypogammaglobulinemia
• CF
• Defective leukocyte function
• Ciliary dysfunction (Kartagener’s syndrome, sinusitis)

Question 9

Signs and symptoms of bronchiectasis?

Answer 9

• Chronic cough + purulent sputum
• Haemoptysis
• Recurrent pneumonia
• Local crackles (insp and exp)
• Wheezes
• Clubbing

Question 10

Ix in bronchiectasis?

Answer 10

• RFTs (obstructive or N)
• CXR
• CT (gold standard)
• Sputum MCS (+AFB)
• Serum Ig levels
• Sweat chloride (if ?CF)

Question 11

Nonspecific CXR features for bronchiectasis?

Answer 11

• Increased markings
• Linear atelectasis
• Loss of vol in affected areas

Question 12

Specific CXR features of bronchiectasis?

Answer 12

• Tram tracking: parallel narrow lines radiating from hilum

- Cystic spaces (like honeycomb)

Question 13

CT features of bronchiectasis?

Answer 13

Signet ring: dilated bronchi w/ thickened walls where diameter bronchus > diameter of accompanying artery.

Question 14

Rx bronchiectasis?

Answer 14

• Vax: flux and pneumovax
• ABx: mild exacerbations
• Inhaled Corticosteroids: decrease inflammation and improve FEV1
• Oral CST: acute, major exacerbations
• Chest physio
• Pulmonary resection (focal bronchiectasis)