Bronchiectasis

Dr / Hytham Nafady

Definition

• Irreversible dilatation of the cartilage containing airways.

Bronchial tree

Types of bronchiectasis

Cylindrical bronchiectasis

Varicose bronchiectasis

Cystic bronchiectasis

Mild Moderate Sever

Tram track appearance

String of beads Cluster of grapes

Cylindrical bronchiectasis

Varicose bronchiectasis

Cystic bronchiectasis

Plain radiographic signs of bronchiectasis

Mucoid impaction

Fluid filled bronchi

CTsigns of bronchiectasis

•Signet ring sign (broncho-arterial ratio > 1).•Lack of bronchial tapering.•Abnormal bronchial contour.•Visibility of peripheral air ways.

Signet ring signbroncho-arterial ratio > 1

Normal bronchus Lack of bronchial tapering

Abnormal bronchial contour

Visibility of peripheral air ways within 1cm from the costal pleura

• Peribronchial cuffing (thickened hazy bronchial wall).

• Finger in glove opacities (mucus filled bronchi).• Multiple air fluid levels (fluid filled bronchi).

Bronchial wall thickening

Mucoid impaction

Multiple air fluid levels

• Mosaic perfusion.• Air trapping.• Tree in bud opacities.

Mosaic perfusion

Air trapping

Tree in budd opacities

Pseudo-bronchiectasis

• Pitfalls in diagnosis of bronchiectasis.

• Motion artifact (respiratory or cardiac motion artifact).

Endobronchial tumor (carcinoid)

Broncholithiasis

Bronchial atresia

Bronchial stenosis

Post-irradiation fibrosis (traction bronchiectasis)

Diffuse bronchiectasiswith central predominance

• ABPA.

• Mounier Kuhn syndrome.

• William Campbell syndrome.

ABPA

Mounier Kuhn syndrometracheobronchomegaly

William Campbell syndrome

Congenital cystic bronchiectasis that results from a deficiency of cartilage in the 4th to 6th order bronchi

Diffuse bronchiectasis with upper lobe predominance

• Cystic fibrosis.

• Sarcoidosis.

Cystic fibrosis

Sarcoidosis

Diffuse bronchiectasis with middle lobe & lingula predominance

• Non tuberculous mycobacterial infection.

• Immobile cilia syndrome.

Mycobacterium avium intercellulare infection

Immotile cilia syndrome

Bronchiectasiswith lower lobe predominance

1. Idiopathic (40% of cases).

2. Recurrent childhood infection.

3. Repeated aspiration.

4. Interstitial lung disease.

Interstitial lung disease

Case

• 65-year-old man with a chronic productive cough and progressive dyspnea on exertion.

Atlas of bronchiectasis

Bronchietasis

Lack of bronchial tapering

+

Tree in bud opacities

LUL bronchiectasis

RML bronchiectasis