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BRONCHIECTASIS
Citadel B. Rabanes, MDFirst Year
JRRMMC- Department of Radiology
Cavities- gas-containing space in the lung with irregular or lobulated wall > 1mm thick
Bulla- air-filled space w/in the lung, 1cm in diameter, thin-walled < 1mm thick
Cyst- air- or fluid-filled space with smooth thin wall >1mm thick, wall contains respiratory epithelium, cartilage, smooth muscles, and glands
Focal Radiolucent Lesions of the Lungs
Bleb- collection of gas < 1cm in size win the layers of the visceral pleura
Pneumatoceles- thin-walled gas-filled space w/in the lung, usually occurring in association w/ acute pneumonia
Focal Radiolucent Lesions of the Lungs
Cavity/cavitation
Bullae
Bleb
Cyst
Pneumatoceles
Irreversible dilation of a portion of the bronchial tree
Cystic fibrosis- most important cause in America and Europe
Bronchiectasis
Infection
Airway obstruction
Peribronchial fibrosis
pathogenesis: 3 mechanisms
Severe childhood pneumonia severe bronchial damage and recurrent infection bronchiectasis
Mechanism: infection
Neoplasm, atresia, or stenosis endobronchial obstruction bronchiectasis
Mechanism: airway obstruction
Parenchymal fibrosis irregular dilatation of bronchial walls bronchiectasis
Mechanism: peribronchial fibrosis
Cough
Purulent sputum production
Hemoptysis
Recurrent fever
main symptoms
Cylindrical bronchiectasis
Saccular/cystic bronchiectasis
Varicose bronchiectasis
3 groups: morphologically
Mild diffuse dilatation of the bronchi
Diffuse mucosal edema with resultant bronchi that are dilated minimally but have straight, regular outlines that end abruptly
Cylindrical bronchiectasis
Seen as clusters of bronchi w/ marked localized saccular dilatation
Has ulceration w/ bronchial neovascularization and resultant ballooned appearance that may have air-fluid levels
Saccular/cystic bronchiectasis
Saccular/Cystic Bronchiectasis
Bronchial dilatation interrupted by focal areas of narrowing, appearance likened to string of pearls
Bulbous appearance w/ dilated bronchus and interspersed site of relative constriction, and potentially obstructive scarring
Varicose bronchiectasis
Parallel line opacities (tram tracks)
Tubular opacities
Ring opacities or cystic spaces
Increase in size and loss of definition of pulmonary markings in specific segmental areas of the lungs
Radiologic Manifestations: Radiography
Radiologic Manifestations: Radiography
Radiologic Manifestations: Radiography
Crowding of PVMs; atelectasis
Evidence of oligemia as a result of reduction in pulmonary artery perfusion
Signs of compensatory overinflation of the remainder of the lung
Radiologic Manifestations: Radiography
HRCT- imaging modality of choice to establish the presence of bronchiectasis and determine its extent
Radiologic Manifestations: Computed Tomography
Internal bronchial diameter greater than that of the adjacent pulmonary artery
Lack of bronchial tapering
Visualization of bronchi w/in 1cm of the costal pleura
Radiologic Manifestations: Computed Tomography
Radiologic Manifestations: Computed Tomography
Radiologic Manifestations: Computed tomography
Visualization of the bronchi abutting the mediastinal pleura
Bronchial wall thickening
Radiologic Manifestations: Computed Tomography
Radiologic Manifestations: Computed Tomography
Was the radiologic gold standard for the demonstration of the presence and extent of bronchiectasis
Replaced by HRCT due to allergic reaction to the bronchographic medium
Bronchography
Cystic Fibrosis
Dyskinetic Cilia Syndrome (Primary Cilia Dyskinesia)
Young’s Syndrome (Obstructive Azoospermia)
Syndrome of yellow nails, lymphedema, pleural effusion, and bronchiectasis
Williams-Campbell Syndrome
Specific Causes
There are multiple cystic lucencies of varying sizes noted in the left parahilar region- left lpwer lobe obscuring the left cardiac border, HD and CPS
The right lung is hyperaerated The heart size cannot be assessed The right HD is depressed BTU
THANK YOU
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