Bronchiectasis

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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101 Bronchiectasis

Instruction

Examine this patient’s chest.

Listen to this patient’s chest.

Salient features

History

• Cough with copious purulent sputum, recurrent haemoptysis

• Intermittent fever and night sweats

• History of recurrent chest infections

• Weight loss.

Examination

• Copious purulent expectoration (remember to check the sputum cup in a chest case)

• Finger clubbing

• Bilateral coarse, late, inspiratory crackles.

Proceed as follows:

• Comment on kyphoscoliosis if any

• Tell the examiner that you would like to know whether the bronchiectasis is long standing; if so, you would like to examine the abdomen for splenomegaly (amyloidosis).

In addition there may be signs of collapse, fibrosis or pneumonia.

Diagnosis

This patient has bilateral, coarse, late inspiratory crackles with purulent sputum (lesion) caused by bronchiectasis (aetiology), and is cyanosed.

Questions

What do you understand by bronchiectasis?

It is a chronic necrotizing infection of the bronchi and bronchioles leading to abnormal, permanent dilatation of the airways.

Mention the causes of bronchiectasis

• Postpneumonic, measles, pertussis, TB

• Mechanical bronchial obstruction, as in TB, carcinoma, nodal compression

• Allergic bronchopulmonary aspergillosis

• Gammaglobulin deficiency, congenital, acquired

• Immotile cilia syndrome (Kartagener syndrome)

• Cystic fibrosis

• Neuropathic disorders (namely Riley–Day syndrome, Chagas’ disease)

• Inflammatory bowel disease, rheumatoid arthritis

• Idiopathic.

What investigations would you do in such a patient?

FBC

Sputum culture

Chest radiography

Bronchography

CT scan of the chest.

Advanced-level questions

How can CT assess bronchiectasis?

High-resolution CT performed at the end of expiration suggests that small airways disease may be an early feature of bronchiectasis, which then leads to more progressive injury and bronchiolar distortion. Larger studies with long-term follow-up are required to confirm this. Conventional CT has a sensitivity of 60–80% for detecting bronchiectasis, whereas high-resolution CT has a sensitivity of >90%, using bronchography as the ‘gold standard’.

Specific abnormalities found on high-resolution CT (Fig. 101.1) include:

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