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Resident Report. 7.26.2011. Bronchiectasis. Irreversibly dilated peripheral airways secondary to chronic inflammation from a variety of causes Pathogenesis – inflammatory damage to bronchial wall leads to cycle of airway inflammation, bacterial colonization and infection that self-perpetuates

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bronchiectasis
Bronchiectasis
  • Irreversibly dilated peripheral airways secondary to chronic inflammation from a variety of causes
  • Pathogenesis – inflammatory damage to bronchial wall leads to cycle of airway inflammation, bacterial colonization and infection that self-perpetuates
  • Reduction of clearance of respiratory secretions
clinical features
Clinical Features
  • Chronic productive cough of purulent sputum
    • Sometimes dry cough can be presenting symptom
  • Frequently see hemoptysis – secondary to dilated bronchial vasculature which sometimes can bleed
  • Physical exam can show rhonchi, rales; often depends on how congested airway is with sputum
causes
Causes
  • Congenital diseases – cystic fibrosis, primary ciliary dyskinesia, alpha-1-antitrypsin deficiency,
  • Infections – recurring pneumonias, non-tuberculous mycobacterial infections (especially MAC), childhood infections
  • Connective tissue disorders – Sjogren’s and RA especially
  • Inflammatory bowel disease
  • ABPA
  • COPD/asthma
  • Chronic Aspiration
  • Idopathic
findings on imaging
Findings on Imaging
  • CXR – often will not be impressive
  • Chest CT is imaging of choice
    • Diameter of dilated airways larger than blood vessels (signet ring formation)
treatment
Treatment
  • Antibiotics – treat based on cultures obtained from sputum cultures
    • Trials with inconclusive evidence done on maintenance abx
  • Inhaled steroids
  • Macrolide antibiotics
  • Inhaled saline solution (mobilization of secretions)
  • Resection and Transplant
take home points
Take Home Points
  • Causes of hemoptysis
  • Workup of hemoptysis
  • Index of suspicion for TB in high risk patients
  • Pathogenesis, clinical features, treatment of bronchiectasis