Bronchiectasis

Question 1

Bronchiectasis chronic condition in which an area of the
bronchial tubes is permanently ___ and ___ (___)

• • Associated with chronic ____ cough +/- other respiratory Sx +/- constitutional Sx

Answer 1

Chronic condition in which an area of the
bronchial tubes is permanently scarred and widened (dilated)
• Associated with chronic productive cough +/- other respiratory Sx +/- constitutional Sx

Question 2

viscious cycle hypothesis

Answer 2

1. significant injury to lung like infection
2. market bronchiole inflammation
3. mucous secretion
4. imparied ciliar
5. more bacteria colonization

Question 3

clinical presentation of bronchiectasis

Answer 3

• dyspnea
• chest pain
• hemoptysis
• recurrent chest infection
• cluvving of nails
• crackles
• wheeze
• cough

sputum

• clubbing is due to cystic fibrosis

Question 4

definition of a bronchiectasis exacerbation

Answer 4

• deterioration in at least 3 or more of: cough, sputum volume and/or consistency, sputum purulence, SOB, exercise tolerance, fatigue, or hemoptysis

• lasting 2 or more days

Question 5

Gold standard method of diagnosing bronchiectasis

Answer 5

high resolution CT

• suspect if daily cough productive of purulent sputum
• on HRCT look for the internal bronchus diameter to be wider than the adjacent artery and failure of the bronchi to taper.
• PFT usually shows airflow obstruction (low FEV1/FVC and FEV1) may have a significant bronchodilator repsonse (not required for Dx but often seen)

Question 6

Classic CT finding of bronchiectasis

Answer 6

signet ring sign

Question 7

Traction bronchiectasis-

Answer 7

airway dilated because lungs are pulled by fibrotic lung

• only seen in intersitital pulmonary lung disease and pulmonary fibrosis.
• lung airway tethered and dilated because of interstitial lung fibrosis. Doesn’t follow viscious cycle hypotheiss and doesn’t alway shave a productive cough.

Question 8

what sign are the arrows

Answer 8

dilated airway indicating TRAM TRACKING– parallel traks. doesn’t taper.

Question 9

Answer 9

Traction bronchiectasis- airways dilated because pulled by fibrotic lung * This is a different etiology, seen in ILD, & managed differently*
- pulmonary fibrosis with periphery reticular pattern.

• always opened and tethered because of scarring.

Question 10

postinfectious conditions, congenital conditions and genetic conditions that can cause/be associated with bronchiectasis

Answer 10

postinfectious conditions: severe bacterial pneumonia, mycobacterium tuberculosis or nontuberculous mycobacteria, fungal infection

congenital conditions: tracheobronchomegaly, marfan’s syndrome

genetic: cystic fibrosis, primary ciliary dykinesia APLA.

Question 11

mechanical obstruction causes of bronchiectasis

Answer 11

• foreign body
• tumor
• extrinsic compression from lymph nodes.

Question 12

Bronchiectasis workup

Answer 12

1. chest Xray
2. high resolution CT
3. PFT
   - then determine underlying cause
   - other possible tests include bronchoscopy, barium swallow, semen analysis, tests for assocaited conditions (ciliary testing), blood testss for rarer immune deficiency

Question 13

overeall classifications for maintenance/prevention of exacerbations

Answer 13

Airway clearance & mucolytics ‘

• Chronic antibiotics

• Antiinflamatories- macrolides. inhaled antibiotics to rerduce flairs and reduce pseudomonas
- hypertonic saline to loosen the sputum

Question 14

during bronchiectasis exacervations, it is very important to sent sputum culture. what is the most common infecting pathogens?

(chronic macrolide therpay may be beneficial). Severe exacerbations may require IV antbiotics.

Answer 14

1. h. influenzae
2. p. aeurginosa
3. moraxella catarrhalis
4. strep pneumoniae
5. staph aureus