Case study (Bronchioectasis)

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1- What is the most probable diagnosis?Bronchioectasis

2- Mention other conditions that can give a similar clinical picture?Supurative Lung Diseases(SLD)a- Lung abcessb- Infected cystic lungc- Empyema with bronchoplueral

fistula3- What is the etiology and pathogenesis

of this patient’s illness? Etiology and pathogenesisa- Congenital bronchiectasis

- 1ryidiopathic- 2ryimmotile cilia syndrome

(bronchiectasis, sinusitis, otitis media, male sterility, kartagner’s syndrome) cystic fibrosis immunodeficiency syndrom

*All this etiologystagnation of Secretionbronchial obstruction2ry infection bronchial dilatation

b- Acquired bronchiectasis

1- Bronchial obstruction- Mechanism:a- Partial obstructionallowing air

entrance during inspiration but prevent air escape during expiration ↑ intrabronchial pressure bronchiectasis/emphysema

b- Complete obstructioncollapse ↑ intra pleural pressure exert traction on bronchus dilatation

c- Accumulation of secretion dilatation of bronchus

- Caused by:a- In the lumen: FB, thick secretionb- In the wall: tumor, broncho-stenosisc- Pressure from outside: LN, tumor

other causes of mediastinal syndrome

2- In fection & fibrosis - Mechanism:a- Severe or recurrent infection

leading to destruction of bronchial muscle & elastic fibersdilatation

b- Peri-bronchial fibrosistraction on bronchial walldilatation

- Common causes:a- Bronchopneumoniab- Whooping cough

c- TBd- Measles

4- How to treat such patient?a- Medical ttt

- Antibiotics (empirical according to C&S)

- Postural drainage- Immunization against influenza &

pneumococcal pneumonia- Bronchodilator (if obstruction is

reversible- Oxygen therapy

b- Surgical resection in early childhood disease and single local airway disease

A 35 years old patient complains of chronic cough and expectoration of excessive purulent sputum averaging 320 ml/day. The condition partly improves with antibiotics to recur again. Expectoration increases on awakening in the morning and on leaning forwards. The patient also has 3rd degree clubbing.