4 bronchiectasis
TRANSCRIPT
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BRONCHIECTASISBRONCHIECTASIS
Zhiwen ZhuThe 1st affiliated hospital of Sun Yat-sen university, pulmonary departme
nt
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BRONCHIECTASIS
Definition Etiology Pathology Clinical presentation Diagnosis & differential diagnosis Treatment
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Definition
Bronchiectasis is a condition anatomically defined by chronic, irreversible dilation and distortion of the bronchi caused by inflammatory destruction of the muscular and elastic components of the bronchial walls.
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Etiology
Conditions associated with the development of bronchiectasis
1. Postinfection• Bacterial pneumonia• Tuberculosis• Pertussis• Measles• Influenza
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Etiology
2. Proximal airway obstruction
• Foreign body aspiration
• Benign airway tumors
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Etiology
2. Proximal airway obstruction
• Middle lobe syndrome Extrinsic compression by enlarged lymph nodes
of the right middle lobe of the lung that obstructed bronchi and lead to right middle lobe atelectasis and recurrent infection.
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Etiology
3.Abnormal host defense • Ciliary dyskinesia ( Kartagener’s syndrome)• Humoral immunodeficiency
4.Genetic disorders• Cystic fibrosis• α1- Antitrypsin deficiency
5.Others
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Pathology
Dilation and distortion of the bronchi Damage of airway epithelium Dilation and hyperplasia of blood capillary
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Clinical presentation
1. The production of large quantities of purulent and often foul-smelling sputum.
The volume of sputum can be used for estimating the severity of the disease
Mild < 10 mL Moderate 10~150 mL Severe >150 mL
※ Dry bronchiectasis usually involve the upper lobes
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Clinical presentation
2. Chronic cough3. Hemoptysis: Frequent More commonly in dry variety Usually mild (blood streaking of purulent sputum) Massive hemoptysis is usually from dilated bronchial arteries or bronchial-
pulmonary anastomoses under systemic pressure 4. Recurrent pneumonia: same segment
5. Systemic manifestations: fever, weight loss
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Clinical presentation
Physical finding Early phases or dry variety: normal Severe or secondary infection: persisting cr
ackling rales in the same part of lung Later stage: digital clubbing, emphysema,
and cor pulmonale.
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Evaluation
1.Roentgenographic studies
• The plain chest film: increased in size and number of bronchovascular markings (quiet nonspecific)
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Evaluation
1.Roentgenographic studies
• Bronchography: (traditional gold standard)
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Evaluation
CT or HRCT: high sensitivity and specificity
Train track sign: the bronchial wall is thicken and visible; the bronchi lose the trend of narrowing from proximal end to distal end.
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Evaluation
CT or HRCT: high sensitivity and specificity
Diamond ring sign: dilated bronchi appear as ring structures with internal diameters greater than those of their accompany pulmonary artery branches.
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Evaluation
2.Bronchoscopy Evaluating the proximal airways for lesion
s. Assessing the cause of hemoptysis Localizing the source of hemoptysis
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Diagnosis
Symptoms Sign reontgenographic fiding
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Differential diagnosis
Differentiate from:
• Chronic bronchitis
No recurrent hemoptysis; CT scan
• Lung abscess
X-ray/CT: local infiltrated shadow or cavitations with air-fluid level inside.
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Differential diagnosis
• Tuberculosis
radiographic finding; sputum anti-fast smear
• Congenital pulmonary cyst
multi thin wall cavities without infiltration around.
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Treatment
Medical management
1. Improving the drainage of airway
1) expectorant
2) bronchodilators
3) postural drainage
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Anterior segment
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Posterior segment of right upper lobe
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Lower lobe
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Treatment
Medical management
1. Improving the drainage of airway
1) expectorant
2) bronchodilators
3) postural drainage
4) bronchoscopy
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Treatment
Medical management
2. Antibiotic The choice of antibiotics should be accurat
ely by the results of sputum culture and drug sensitivity test.
Empirical therapy ---antipseudomonal antibiotics.
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Treatment
Surgical therapy
1. Recurrent and refractory clinical symptoms are due to a focal area of disease involvement.
2. Massive hemoptysis Management of hemoptysis
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