A number of features are helpful in diagnosing bronchiectasis 8,9: A number of ancillary findings are also recognized: In general, the treatment of bronchiectasis is medical and involves promoting sputum clearance, using positional physiotherapy, and early and aggressive treatment of pulmonary infections. (a) Axial minimum intensity projection CT image obtained several days after presentation shows mild cylindrical bronchial dilatation. 9. 3, Contemporary Diagnostic Radiology, Vol. Movie 2 Cellular mechanisms of bronchiectasis. (b) Sagittal reformatted minimum intensity projection CT image shows tubular interconnected airways, a finding that helps distinguish bronchiolectasis from honeycombing or paraseptal emphysema. Mosaic attenuation throughout the lungs is present; lower-attenuation regions represent airtrapping, and higher-attenuation areas represent normal lung. (b) Sagittal reformatted minimum intensity projection CT image shows tubular interconnected airways, a finding that helps distinguish bronchiolectasis from honeycombing or paraseptal emphysema. Causes include 1-7,9,17,21: A mnemonic to remember common causes is CAPT Kangaroo has Mounier-Kuhn. Attention to craniocaudal and axial versus peripheral distribution is important because this often provides valuable clues to a specific diagnosis (Table), such as in the case of sarcoidosis, in which a bilateral symmetric upper lobe predominance is shown, or in allergic bronchopulmonary aspergillosis, which typically affects central airways. Bronchiectasis represents both an important potential cause of morbidity (usually associated with recurrent infection and related complications) and a valuable indicator of underlying pulmonary disease. 2. (b) Coronal reformatted minimum intensity projection CT image shows left lower lobe bronchial occlusion due to the endobronchial component of the tumor, with accompanying cystic and varicoid left lower lobe bronchiectasis. Description. Figure 9b (a, b) Rapidly progressing bronchial dilatation and bronchiectasis in a 70-year-old woman with acute respiratory distress syndrome due to pneumonia. Airtrapping secondary to airway collapse in the context of excessively compliant bronchial walls can also be seen (51). Postprimary tuberculosis usually involves the upper lobes, can cavitate, and may involve a prominent endobronchial component (34). A prospective study of 245 patients revealed a 5-year mortality rate of 20.4%, and patients with accompanying chronic obstructive pulmonary disease had a higher mortality rate of 55% (6). It does not provide medical advice, diagnosis or treatment. Slow-growing tumors with an endobronchial and/or peribronchial component may lead to bronchiectasis in a lobe, segment, or smaller-order bronchus, possibly due to a ball-valve mechanism. Swyer-James Syndrome.—Swyer-James syndrome is a manifestation of postinfectious bronchiolitis obliterans and usually occurs during childhood, with a resultant smaller lucent lung usually accompanied by diffuse bronchiectasis. Note the normal caliber of the trachea and proximal bronchi, an appearance compatible with Williams-Campbell syndrome. (2015) Radiographics : a review publication of the Radiological Society of North America, Inc. 35 (4): 1011-30. Two groups make up the majority of cases: post-infectious and cystic fibrosis 3. 50, No. Allergic Bronchopulmonary Aspergillosis.—Allergic bronchopulmonary aspergillosis is characterized by chronic airway inflammation, damage, and remodeling resulting from a reaction to the presence of endobronchial Aspergillus species (allergic bronchopulmonary mycosis is the more general term used when the reaction is attributable to nonaspergillus species). Pulmonary artery (PA) dilation is an increasingly common cause of medical consultation. According to macroscopic morphology, three types have been described, which also represent a spectrum of severity 8: According to one study, the relative prevalence of bronchiectatic changes were 14: Additionally, bronchiectasis can result from the traction of fibrotic lung surrounding an airway. Figure 4c Cystic fibrosis in a man from ages 19 to 26 years. This patient’s high-resolution CT chest showed a UIP (usual interstitial pneumonia) pattern: the fibrotic changes predominate in the lung bases and subpleural regions, and are associated with honeycombing (orange arrows) and traction bronchiectasis (yellow arrows). (a) Posteroanterior chest radiograph shows upper lobe–predominant reticulonodular opacities and elevation of both hila due to upper lobe volume loss. In patients with α1-antitrypsin deficiency who develop bronchiectasis, the distribution tends to follow the emphysematous changes, with greater severity in the lower lungs (49). Bronchial wall thickening, aspirated material in the trachea or bronchi, and the presence of a hiatal hernia are other clues to the diagnosis. Bronchiectasis in the lower lungs to a greater extent than the degree of perceived fibrosis and honeycombing is suggestive of a nonspecific interstitial pneumonia pattern and is often seen in patients with scleroderma (Fig 12); both traction resulting from interstitial fibrosis and chronic aspiration likely contribute to this pattern of bronchiectasis. Kartagener syndrome refers to the clinical combination of situs inversus, chronic sinusitis, and bronchiectasis in a subset of patients with ciliary dyskinesia. (b) Coronal reformatted CT image shows corresponding dilated bronchi with thickened walls and cylindrical and cystic bronchiectasis. The authors will also present an approach emphasizing the distribution (apical versus basal and central versus peripheral) and concomitant findings, such as nodules, cavities, and/or lymphadenopathy, that can assist in narrowing the differential diagnosis. Note that the bronchiectasis follows the overall pattern of fibrosis, with greater traction and varicosity of bronchi in areas of honeycombing and architectural distortion. Figure 2: gross pathology: bronchiectatic lung, Case 19: cylindrical due to pulmonary tuberculosis, Case 21: post obstructive secondary to endobronchial carcinoid, Mycobacterium avium-intracellulare complex, allergic bronchopulmonary aspergillosis (ABPA), chronic obstructive pulmonary disease (COPD), lymphocytic interstitial pneumonitis (LIP), acute unilateral airspace opacification (differential), acute bilateral airspace opacification (differential), acute airspace opacification with lymphadenopathy (differential), chronic unilateral airspace opacification (differential), chronic bilateral airspace opacification (differential), osteophyte induced adjacent pulmonary atelectasis and fibrosis, pediatric chest x-ray in the exam setting, normal chest x-ray appearance of the diaphragm, posterior tracheal stripe/tracheo-esophageal stripe, obliteration of the retrosternal airspace, leflunomide-induced acute interstitial pneumonia, fibrotic non-specific interstitial pneumonia, cellular non-specific interstitial pneumonia, respiratory bronchiolitis–associated interstitial lung disease, diagnostic HRCT criteria for UIP pattern - ATS/ERS/JRS/ALAT (2011), diagnostic HRCT criteria for UIP pattern - Fleischner society guideline (2018), domestically acquired particulate lung disease, lepidic predominant adenocarcinoma (formerly non-mucinous BAC), micropapillary predominant adenocarcinoma, invasive mucinous adenocarcinoma (formerly mucinous BAC), lung cancer associated with cystic airspaces, primary sarcomatoid carcinoma of the lung, large cell neuroendocrine cell carcinoma of the lung, squamous cell carcinoma in situ (CIS) of lung, minimally invasive adenocarcinoma of the lung, diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH), calcifying fibrous pseudotumor of the lung, IASLC (International Association for the Study of Lung Cancer) 8th edition (current), IASLC (International Association for the Study of Lung Cancer) 7th edition (superseeded), 1996 AJCC-UICC Regional Lymph Node Classification for Lung Cancer Staging, postinfective (most common known non-CF cause in adults), bronchi have a uniform caliber, do not taper and have parallel walls (, beaded appearances where dilated bronchi have interspersed sites of relative narrowing, severe form with cyst-like bronchi that extend to the pleural surface, bronchus visualized within 1 cm of the pleural surface, especially true of lung adjacent to costal pleura, most helpful sign for early cylindrical change, diameter of a bronchus should measure approximately 0.65-1.0 times that of the adjacent pulmonary artery branch, between 1 and 1.5 may be seen in normal individuals, especially those living at high altitude, greater than 1.5 indicates bronchiectasis, bronchial wall thickening: normally wall of bronchus should be less than half the width of the accompanying pulmonary artery branch, causes of a particular distribution of bronchiectasis. More recently, volumetric thin-section CT has become popular for the assessment of diffuse lung disease, with helical CT acquisitions generally at 1–1.25-mm section thicknesses. Clinical, radiologic, and functional evaluation of 304 patients with bronchiectasis. What is spirometry? However, in postprimary tuberculosis, previously contained primary infection becomes active infection usually during a period of immunosuppression, malnutrition, or other debilitation. Even in severe cases, they could be life-threatening. Infection leads to impaired ciliary function, limiting the ability of the airway to clear harmful organisms and inflammatory substances. In the case of usual interstitial pneumonia, fibrosis is most pronounced in the peripheral lower lung zones. Chest radiography is relatively insensitive for detection of bronchiectasis (20). Naidich DP, Srichai MB, Krinsky GA. Computed tomography and magnetic resonance of the thorax. Chest radiographs may show a basilar anterior predominance of small nodules, bronchiectasis, and atelectasis or scarring; however, radiographic findings can often be subtle or nonspecific (Fig 8a). 1, European Respiratory Journal, Vol. (2005) ISBN:0198569785. Axial minimum intensity projection CT images show cylindrical bronchiectasis (a), which is seen as a smooth tubular contour and is the most common morphologic type; varicoid bronchiectasis (b), which appears as an undulating irregular contour and often occurs in processes involving fibrosis; and cystic bronchiectasis (c), which is characterized by saccular dilatation of the airways and is classically seen in cystic fibrosis but can occur in many other contexts. 13 December 2016 | Insights into imaging, Vol, can lead to infection and worsening.... And affects men more frequently than women ; treatment includes a multidrug regimen typically prescribed for at 1... 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