4 bronchiectasis


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4 bronchiectasis

  1. 1. BRONCHIECTASIS Zhiwen Zhu The 1 st affiliated hospital of Sun Yat-sen university, pulmonary department
  2. 2. BRONCHIECTASIS <ul><li>Definition </li></ul><ul><li>Etiology </li></ul><ul><li>Pathology </li></ul><ul><li>Clinical presentation </li></ul><ul><li>Diagnosis & differential diagnosis </li></ul><ul><li>Treatment </li></ul>
  3. 3. Definition <ul><li>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. </li></ul>
  4. 4. Etiology <ul><li>Conditions associated with the development of bronchiectasis </li></ul><ul><li>1. Postinfection </li></ul><ul><li>Bacterial pneumonia </li></ul><ul><li>Tuberculosis </li></ul><ul><li>Pertussis </li></ul><ul><li>Measles </li></ul><ul><li>Influenza </li></ul>
  5. 5. Etiology <ul><li>2. Proximal airway obstruction </li></ul><ul><li>Foreign body aspiration </li></ul><ul><li>Benign airway tumors </li></ul>
  6. 8. Etiology <ul><li>2. Proximal airway obstruction </li></ul><ul><li>Middle lobe syndrome </li></ul><ul><li>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. </li></ul>
  7. 9. Etiology <ul><li>3.Abnormal host defense </li></ul><ul><li>Ciliary dyskinesia ( Kartagener’s syndrome) </li></ul><ul><li>Humoral immunodeficiency </li></ul><ul><li>4.Genetic disorders </li></ul><ul><li>Cystic fibrosis </li></ul><ul><li>α1- Antitrypsin deficiency </li></ul><ul><li>5.Others </li></ul>
  8. 10. Pathology <ul><li>Dilation and distortion of the bronchi </li></ul><ul><li>Damage of airway epithelium </li></ul><ul><li>Dilation and hyperplasia of blood capillary </li></ul>
  9. 14. Clinical presentation <ul><li>The production of large quantities of purulent and often foul-smelling sputum. </li></ul><ul><li>The volume of sputum can be used for estimating the severity of the disease </li></ul><ul><li>Mild < 10 mL </li></ul><ul><li>Moderate 10~150 mL </li></ul><ul><li>Severe >150 mL </li></ul><ul><li>※ Dry bronchiectasis </li></ul><ul><li>usually involve the upper lobes </li></ul>
  10. 15. Clinical presentation <ul><li>2. Chronic cough </li></ul><ul><li>3. Hemoptysis: </li></ul><ul><li>Frequent </li></ul><ul><li>More commonly in dry variety </li></ul><ul><li>Usually mild (blood streaking of purulent sputum) </li></ul><ul><li>Massive hemoptysis is usually from dilated bronchial arteries or bronchial-pulmonary anastomoses under systemic pressure </li></ul><ul><li>4. Recurrent pneumonia: </li></ul><ul><li>same segment </li></ul><ul><li>5. Systemic manifestations: </li></ul><ul><li>fever, weight loss </li></ul>
  11. 16. Clinical presentation <ul><li>Physical finding </li></ul><ul><li>Early phases or dry variety: normal </li></ul><ul><li>Severe or secondary infection: persisting crackling rales in the same part of lung </li></ul><ul><li>Later stage: digital clubbing, emphysema, and cor pulmonale. </li></ul>
  12. 17. Evaluation <ul><li>1.Roentgenographic studies </li></ul><ul><li>The plain chest film: increased in size and number of bronchovascular markings (quiet nonspecific) </li></ul>
  13. 19. Evaluation <ul><li>1.Roentgenographic studies </li></ul><ul><li>Bronchography: (traditional gold standard) </li></ul>
  14. 21. Evaluation <ul><li>CT or HRCT: high sensitivity and specificity </li></ul><ul><li>Train track sign: the bronchial wall is thicken and visible; the bronchi lose the trend of narrowing from proximal end to distal end. </li></ul>
  15. 24. Evaluation <ul><li>CT or HRCT: high sensitivity and specificity </li></ul><ul><li>Diamond ring sign: dilated bronchi appear as ring structures with internal diameters greater than those of their accompany pulmonary artery branches. </li></ul>
  16. 28. Evaluation <ul><li>2.Bronchoscopy </li></ul><ul><li>Evaluating the proximal airways for lesions. </li></ul><ul><li>Assessing the cause of hemoptysis </li></ul><ul><li>Localizing the source of hemoptysis </li></ul>
  17. 30. Diagnosis <ul><li>Symptoms </li></ul><ul><li>Sign </li></ul><ul><li>reontgenographic fiding </li></ul>
  18. 31. Differential diagnosis <ul><li>Differentiate from: </li></ul><ul><li>Chronic bronchitis </li></ul><ul><li>No recurrent hemoptysis; CT scan </li></ul><ul><li>Lung abscess </li></ul><ul><li>X-ray/CT: local infiltrated shadow or cavitations with air-fluid level inside. </li></ul>
  19. 32. Differential diagnosis <ul><li>Tuberculosis </li></ul><ul><li>radiographic finding; sputum anti-fast smear </li></ul><ul><li>Congenital pulmonary cyst </li></ul><ul><li>multi thin wall cavities without infiltration around. </li></ul>
  20. 33. Treatment <ul><li>Medical management </li></ul><ul><li>1. Improving the drainage of airway </li></ul><ul><li>1) expectorant </li></ul><ul><li>2) bronchodilators </li></ul><ul><li>3) postural drainage </li></ul>
  21. 34. Anterior segment
  22. 35. Posterior segment of right upper lobe
  23. 36. Lower lobe
  24. 37. Treatment <ul><li>Medical management </li></ul><ul><li>1. Improving the drainage of airway </li></ul><ul><li>1) expectorant </li></ul><ul><li>2) bronchodilators </li></ul><ul><li>3) postural drainage </li></ul><ul><li>4) bronchoscopy </li></ul>
  25. 38. Treatment <ul><li>Medical management </li></ul><ul><li>2. Antibiotic </li></ul><ul><li>The choice of antibiotics should be accurately by the results of sputum culture and drug sensitivity test. </li></ul><ul><li>Empirical therapy ---antipseudomonal antibiotics. </li></ul>
  26. 39. Treatment <ul><li>Surgical therapy </li></ul><ul><li>Recurrent and refractory clinical symptoms are due to a focal area of disease involvement. </li></ul><ul><li>Massive hemoptysis </li></ul><ul><li>Management of hemoptysis </li></ul>
  27. 40. THANK YOU!!!