Bronchiectasis

Aka: Bronchiectasis

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II. Epidemiology

  1. Onset: middle aged

III. Pathophysiology

  1. Chronic inflammatory or infectious pulmonary process
  2. Results in multiple dilatations of small Bronchi
  3. Bronchi exude pustular discharge

IV. Causes

  1. Bronchial obstruction
  2. Recurrent or severe pulmonary infections
    1. Necrotizing pulmonary infection
    2. Pulmonary Abscess
    3. Tuberculosis
    4. Aspergillosis
    5. Measles
    6. Pertussis
    7. RSV Bronchiolitis
  3. Hypergammaglobulinemia
  4. Dyskinetic cilia syndrome
  5. Kartagener's Syndrome
  6. Alpha-1 Antitrypsin Deficiency
  7. Cystic Fibrosis
  8. Inhalation of noxious chemicals

V. Symptoms

  1. Productive cough
    1. Copious Sputum (200-500 ml/day)
    2. Sputum thick, mucopurulent and foul-smelling
    3. Hemoptysis
  2. Wheezing
  3. Dyspnea
  4. Halitosis
  5. Fatigue
  6. Weight loss to Emaciation

VI. Signs

  1. Lung auscultation
    1. Coarse or moist crackles
    2. Rales and Rhonchi
    3. Wheezing
    4. Diminished breath sounds
  2. Cyanosis
  3. Digital Clubbing

VII. Differential Diagnosis

  1. Chronic Obstructive Pulmonary Disease (COPD)
  2. Cystic Fibrosis
  3. Pulmonary Tuberculosis

VIII. Labs: Sputum

  1. Sputum forms layers on standing
    1. Top: Mucus
    2. Middle: Clear fluid
    3. Bottom: Pus
  2. Sputum Culture not diagnostic (mixture of organisms)
  3. Fungal Culture

IX. Imaging: Chest XRay

  1. Often normal, even in advanced disease
  2. May show increased density at lung bases
  3. Airways may be dilated and thickened ("ring shadow")
  4. Atelectasis may be present

X. Diagnosis

  1. Pulmonary Function Tests
    1. Airflow obstruction with reversible component
  2. Diagnostic postural drainage
    1. Patient lies prone in Trendelenburg for 5-15 minutes
    2. Head over edge of table, and pan on floor
    3. Patient coughs several times and pus rolls into pan
  3. Bronchograms with opaque medium
  4. Bronchoscopy
  5. High-resolution Chest CT
    1. Airways are thick and filled with mucous

XI. Management

  1. Pulmonary toilet (chest PT or VEST Therapy)
  2. Inhaled Corticosteroids
  3. Hypertonic Saline nebs
  4. Macrolide Antibiotics

XII. Course

  1. Chronic progressive with exacerbations

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Related Studies

Ontology: Bronchiectasis (C0006267)

Definition (MSHCZE) Chorobné a trvalé rozšíření průdušek. Někdy je vrozené, častěji vzniká jako následek některých (zejména opakovaných) zánětů. (cit. Velký lékařský slovník online, 2012 http://lekarske.slovniky.cz/ )
Definition (NCI) Segmental, irreversible dilation of the bronchial tree resulting in the accumulation of secretions which leads to obstruction. The most common cause is bacterial infection.
Definition (CSP) persistent abnormal dilatation of the bronchi.
Definition (MSH) Persistent abnormal dilatation of the bronchi.
Concepts Disease or Syndrome (T047)
MSH D001987
ICD9 494
ICD10 J47 , J47.9
SnomedCT 195986009, 155580000, 12295008
English Bronchiectasis, BRONCHIECTASIS, Bronchiectasis NOS, bronchiectasis, bronchiectasis (diagnosis), Bronchiectasis [Disease/Finding], bronchiectasis nos, bronchiectases, Bronchiectases, Bronchiectasis NOS (disorder), Chronic dilatation of bronchus and bronchiole, Bronchi dilated, Bronchiectasis (disorder), Bronchiectasis, NOS
French BRONCHECTASIE, Bronchectasie SAI, Bronchiectasie, Bronchectasie, Dilatation des bronches (DDB), Dilatation des bronches
Portuguese BRONQUIECTASIA, Bronquiectasia NE, Bronquectasia, Bronquiectasia
German BRONCHIEKTASE, Bronchiektase NNB, Bronchiektasen, Bronchiektase, Bronchiektasien
Italian Bronchiectasie, Bronchiectasia NAS, Bronchiettasia
Dutch bronchiëctasie NAO, bronchiëctasie, Bronchiëctasie
Spanish Bronquiectasia NEOM, BRONQUIECTASIAS, bronquiectasia, SAI, bronquiectasia, SAI (trastorno), bronquiectasia (trastorno), bronquiectasia, Bronquiectasia
Japanese 気管支拡張症ＮＯＳ, 気管支拡張症, ｷｶﾝｼｶｸﾁｮｳｼｮｳ, ｷｶﾝｼｶｸﾁｮｳｼｮｳNOS
Swedish Bronkutvidgning
Finnish Bronkiektasiatauti
Russian BRONKHOEKTAZIIA, БРОНХОЭКТАЗИЯ
Czech Bronchiektázie NOS, Bronchiektázie, bronchiektázie, bronchiektazie
Korean 기관지확장증
Croatian BRONHIEKTAZIJA
Polish Rozstrzenie oskrzeli, Rozszerzenie oskrzeli
Hungarian bronchiectasia, bronchiectasia k.m.n.
Norwegian Bronkiektasi
Derived from the NIH UMLS (Unified Medical Language System)

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