bronchiectasis.ppt (2)

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

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