Bronchiectasis def., causes,clinical picture, investigations, complications, treatment

This article is to discuss bronchiectasis regarding its definition, sites (types) , aetiology , symptoms, signs ,diagnostic investigations , complications and treatment .

What is meant by Bronchiectasis ?

 It is pathologic irreversible dilatation of the bronchi and bronchioles caused by destruction of the bronchial wall, usually resulting from necrotizing suppurative
infection of bronchi and bronchioles .

Aetiology & Pathogenesis

Obstruction (stasis with increase of the intrabronchial pressure)<===>Infection destroys the bronchial wall with increase of the bronchial secretions ===> Dilated & suppurated bronchi and bronchioles ===> Bronchiactasis .

Causes of Bronchiectasis 

A. Congenital
Bronchiectasis-causes
B. Acquired



The small bronchi of childhood are most susceptible to bronchial infection and to obstruction by impacted secretions, foreign bodies or compressing lymph nodes.
Seventy-five percent of patients can recall experiencing symptoms of bronchiectasis as early as the age of 5 years .

Chronic bronchitis is one of the commonest causes of bronchiactasis, this is due to partial obstruction and recurrent infections .

Sites

 1- Bilateral & basal (areas of poor drainage)
2- Apical on top of  T.B or  Friedlander pneumonia
This is called bronchiectasis sicca haemorrgica (Haemoptysis + scanty sputum).
3- Right middle lobe $ (Brock's syndrome)
The right middle bronchus surrounded by lymph nodes ===> Infections leading to lymph nodes enlargement ===> Compression of the middle bronchus (obstruction with stasis) ===> Infection ===> Bronchiectasis
This may be caused by T.B., measles or whooping cough.
sites-of-bronchiectasis

How to diagnose bronchiectasis ?

Clinical picture
 Bronchiactasis is an obstructive and suppurative lung disease.
Symptoms
1- Fever, Anorexia, Headache, Malaise .
2- Cavitary$ ( Sputum, Foited [bad odour], Increased on stooping forwards )
3- Haemoptysis (due to mucosal ulceration)
4- Dyspnea due to fibrosis and airway obstruction.
5- Chest pain  due to: Muscle Pain, Pleuritic Pain, Pneumothorax .

Signs
General  :
- Toxemia
- Clubbing - puffiness of eye lids (chronic cough)
- Edema due to : Cor Pulmonale , Hypoproteinemia and amyloidosis kidney .
 Local  :
• Inspection: Diminished movement, retraction with fibrosis (basal)
• Palpation: • TVF high in lower lung zone (cavitation)
                  • TVF  Low in upper lung zone (compensatory emphysema)
                  • Diminished chest expansion.
• Percussion :   • Dullness in the lower lung zone (cavitation, fibrosis).
                        • Hyperresonance in upper lung zone (compensatory emphysema)
• Auscultation: • Obstruction ==> Rhonchi, harsh vesicular breathing.
• Secretions ==> Crepitations (coarse consonating crepitations)
• Cavitation ==> Bronchial breathing + bronchophony and whispering .

Investigations
1) Culture& Sensitivity
2) Plain x-ray ===> Honey comb appearance (basal)
3) Bronchography (old method), it is replaced by CT scan.
4) CT scan the best (can detect early bronchial dilatation) particularly high resolution CT scanning.
5) Pulmonary function tests may reveal either restrictive or a mixture of restrictive and obstructive ventilatory patterns.

complications of bronchiectasis

complications-of-bronchiectasis

Treatment of bronchiectasis

1) Postural drainage of sputum.
2) Antibiotic according to culture and sensitivity, flucloxacillin 500mg/6h for staph, ceftazidime 2 gm I.V/8hr or by inhalation 1gm/12hrs for pseudomonase, other
antibiotics can be used e.g ciprofloxacine or inhaled to topramycin.
3) Expectorant &bronchodilator for bronchial drainage.
4) Surgery (lobectomy) for localized lesion causing :
a. Persistent haemoptysis
b. Persistent infection
5) Influenza and pneumococcal vaccines
* Bronchiectasis is rarely sufficiently localized for surgery, lung or heart lung transplantation is sometimes required .

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