Bronchiectasis Flashcards
What is bronchiectasis?
Irreversible dilatation of airways resulting from inflammatory destruction of airway walls due to chronically infected mucous.
Where does bronchiectasis usually affect?
Medium sized airways
Common pathogens in bronchiectasis?
P. aeruginosa most common.
Also S. aureus, H. influenzae
What is the broad aetiology of bronchiectasis?
- Obstruction
- Post infection
- Impaired defences
What are the obstructive causes of bronchiectasis?
- Tumour
- Foreign body
- Thick mucous
Which infections may produce post-infectious bronchiectasis?
- Pneumonia
- TB
- Measles
- Pertussis
- ABPA
- MAC (mycobacterium avium complex)
How do impaired defences precipitate bronchiectasis?
Leads to interference of drainage, chronic infections and inflammation.
Examples of impaired defences which may precipitate bronchiectasis?
- Hypogammaglobulinemia
- CF
- Defective leukocyte function
- Ciliary dysfunction (Kartagener’s syndrome, sinusitis)
Signs and symptoms of bronchiectasis?
- Chronic cough + purulent sputum
- Haemoptysis
- Recurrent pneumonia
- Local crackles (insp and exp)
- Wheezes
- Clubbing
Ix in bronchiectasis?
- RFTs (obstructive or N)
- CXR
- CT (gold standard)
- Sputum MCS (+AFB)
- Serum Ig levels
- Sweat chloride (if ?CF)
Nonspecific CXR features for bronchiectasis?
- Increased markings
- Linear atelectasis
- Loss of vol in affected areas
Specific CXR features of bronchiectasis?
- Tram tracking: parallel narrow lines radiating from hilum
- Cystic spaces (like honeycomb)
CT features of bronchiectasis?
Signet ring: dilated bronchi w/ thickened walls where diameter bronchus > diameter of accompanying artery.
Rx bronchiectasis?
- 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)
