Hope u like it...:)

1. BRONCHIECTASIS
Prepared By:
Sharmin Susiwala

3. Definition:
 Bronkos + Ectasia = Bronchi +
Dilatation
 Localized, irreversible dilation of part
of the bronchial tree/bronchi with
destruction of their elastic and
muscular component, usually due to
acute or chronic infection.
 It is classified as an obstructive lung
disease.

4. Etiology:
 The induction of bronchiectasis requires two factors:
(1) an infectious insult
(2) impairment of drainage, airway obstruction.
 Bronchiectasis is often caused by recurrent inflammation
or infection of the airways.
 Occur along with
 - emphysema
 - bronchitis
 - asthma
 - cystic fibrosis.
 Involved bronchi are dilated, inflamed, and easily
collapsible, resulting in airflow obstruction and impaired
clearance of secretions.

5.  If the condition is present at birth, it is called congenital
bronchiectasis.
 If it develops later in life, it is called acquired
bronchiectasis.
 Acquired causes
 Acquired Immune Deficiency Syndrome (AIDS)
 Tuberculosis / Endobronchial tuberculosis
 Bronchial stenosis
 Secondary traction from fibrosis.
 Inflammatory bowel disease, especially ulcerative colitis.
 Crohn's disease
 Allergic responses to inhaled fungus spores
 Hiatal hernia can cause Bronchiectasis when the
stomach acid that is aspirated into the lungs causes
tissue damage.
 Rheumatoid arthritis
 Cigarette smoke is a specific primary cause of
bronchiectasis remains unclear.

6. Bronchiectasis is associated with a wide range
of disorders, but it usually results from bacterial
infections, such as
 Staphylococcus
 Klebsiella species
 Bordetella pertussis.
Airway obstruction due to foreign body
aspiration.
Inhalation and aspiration of ammonia and other
toxic gases
Alcoholism
heroin (drug use)
Allergic bronchopulmonary aspergillosis

7.  Congenital causes
 Humoral Immunodeficiency:
Hypogammaglobulinemia (IgG,IgG2)
 Kartagener syndrome, which affects the mobility
of cilia in the lungs.
 Another common genetic cause is cystic fibrosis
 Young's syndrome, this is due to the occurrence
of chronic, sinopulmonary infections
 Alpha 1-antitrypsin deficiency
 Primary immunodeficiencies
 Congenital disorders can also lead to
bronchiectasis, includes:
- Williams-Campbell syndrome
- Marfan syndrome

8. Pathology:

9.  The affected areas show a variety of changes
including transmural inflammation, mucosal
edema, cratering and ulceration with bronchial
neovascularization, and distortion due to
scarring or obstruction from repeated infection .
 The obstruction often leads to postobstructive
pneumonitis that may temporarily or
permanently damage the lung parenchyma
 Involved bronchi are dilated, inflamed, and
easily collapsible, resulting in airflow
obstructionand impaired clearance of
secretions.

10. Clinical Features:
 Cough
 Daily sputum production green/yellow sputum (patients with
bronchiectasis may produce 240ml (8 oz) of sputum daily).
 Dyspnea
 Wheezing
 Hemoptysis
 Bluish skin color
 Recurrent pleurisy
 Dry Bronchiectasis
 Breath odor
 Clubbing of fingers
 Fatigue
 Paleness
 Weight loss
 Acute exacerbation
 Late : hypoxemia and hypercapnia

11. Diagnosis:
 ABNORMAL LUNG SOUNDS:
Crackles, wheezes, rhonchi
 CHEST RADIOGRAPHY:
Abnormal (>90%), Suspicious but not diagnostic radiographic findings include:
focal pneumonitis, scattered irregular opacities that may represent mucopurulent plugs, linear or
plate-like atelectasis , dilated and thickened airways that appear as ring-like shadows (of
airways that are seen on end) or tram lines (in the case of airways that are perpendicular to the
x-ray beam)
 HIGH-RESOLUTION COMPUTED TOMOGRAPHIC SCANNING:
"tree-in-bud" abnormalities
The major features of bronchiectasis on HRCT include airway dilatation and bronchial wall
thickening
 BRONCHOSCOPY:
For diagnosis of tumor, foreign body, localize site of hemoptysis.
PULMONARY FUNCTION TESTS

12. Treatment:
 Goals:
1. Controlling infections and bronchial secretions
2. Relieving airway obstructions
3. Removal of affected portions of lung by surgical
removal or artery embolization
4. Preventing complications.
 Treatment of bronchiectasis includes:
 The prolonged usage of antibiotics to prevent
detrimental infections
 Eliminating accumulated fluid with postural drainage and
chest physiotherapy
 Surgery may also be used to treat localized
bronchiectasis, removing obstructions that could cause
progression of the disease.

13.  Inhaled steroid therapy that is consistently adhered to can:
 Reduce sputum production
 Decrease airway constriction over a period of time, and
 Prevent progression of bronchiectasis.
 One commonly used therapy is beclometasone dipropionate, which
is also used in asthma treatment.
 Use o f inhalers such as albuterol (salbutamol), fluticasone
(Flovent/Flixotide) and ipratropium (Atrovent) may help reduce
likelihood of infection by clearing the airways and decreasing
inflammation.
 ACBT (Active Cycle Breathing Techniques) can be useful in the
clearance of sputum
 These techniques encourage relaxed, diaphragmatic breathing,
greater expansion (via collateral inflation) of otherwise consolidated
areas of the lungs, and help in mucociliary clearance (MCC).
 A useful adjunct to these cycles are manual techniques, wherein the
healthcare professional uses percussion, vibrations, and shaking, to
dislodge sputum from the chest walls, enabling the patient to
expectorate more easily.

14. Prevention:
 Immunization against
measles, pertussis and other acute
respiratory infections of childhood.
 Bronchial Hygiene
 Avoiding URTI, smoking and pollution

15. Complications:
 Cor pulmonale
 Coughing up blood
 Low oxygen levels (in severe cases)
 Recurrent pneumonia

16. Images: SEVERE BRONCHIECTASIS

17. Bronchiectasis
Dextrocardia
KARTAGENER’S SYNDROME

18. CYSTIC FIBROSIS

21. LUNG ABSCESS
Prepared By:
Sharmin Susiwala

22. DEFINITION:
 Lung abscess is necrosis of the pulmonary tissue and
formation of cavities (more than 2 cm) containing
necrotic debris or fluid caused by microbial infection.
 This pus-filled cavity is often caused by aspiration, which
may occur during altered consciousness.

23. TYPES:
 Lung abscess is considered
 Primary (60%): when it results from existing
lung parenchymal process
 Secondary: when it complicates another
process e.g. vascular emboli or follows rupture
of extrapulmonary abscess into lung.

24. CAUSES:
 Conditions contributing to lung abscess:
 Aspiration of oropharyngeal or gastric secretion
 Septic emboli
 Necrotizing pneumonia
 Vasculitis: Wegener's granulomatosis
 Necrotizing tumors: 8% to 18% are due to neoplasms across all age
groups, higher in older people; primary squamous carcinoma of the
lung is the most common.
 Organisms
 In the post-antibiotic era pattern of frequency is changing. In older
studies anaerobes were found in up to 90% cases but they are much
less frequent now.
 Anaerobic bacteria: Peptostreptococcus, Bacteroides, Fusobacterium
species
 Aerobicbacteria: Staphylococcus, Klebsiella, Haemophilus, Pseudom
onas, Nocardia, Escherichia coli, Streptococcus, Mycobacteria
 Fungi: Candida, Aspergillus
 Parasites: Entamoeba histolytica

25. SIGNS AND SYMPTOMS:
 Onset of symptoms is often gradua
 Cough
 Fever with shivering
 Night sweats
 Cough can be productive with foul smelling purulent sputum(≈70%)
or less frequently with blood (i.e. hemoptysis in one third cases).
 Chest pain
 Shortness of breath
 Lethargy and other features of chronic illness.
 Patients are generally cachectic at presentation.
 Finger clubbing is present in one third of patients.
 Dental decay is common especially in alcoholics and children.
 On examination of chest there will be features of consolidation such
as localised dullness on percussion, bronchial breath sound etc.

26. DIAGNOSIS:

27.  Chest Xray and other imaging studies
 Abscess is often unilateral and single involving posterior
segments of the upper lobes and the apical segments of the
lower lobes as these areas are gravity dependent when lying
down.
 Presence of air-fluid levels implies rupture into the bronchial
tree or rarely growth of gas forming organism.
 Laboratory studies
 Raised inflammatory markers (high ESR, CRP) are usual but not
specific.
 Examination of sputum is important in any pulmonary infections
and here often reveals mixed flora.
 Transtracheal of Transbronchial (via bronchoscopy) aspirates can
also be cultured.
 Fibre optic bronchoscopy is often performed to exclude
obstructive lesion; it also helps in bronchial drainage of pus.

28. MANAGEMENT:
 Broadspectrum antibiotic to cover
mixed flora is the mainstay of
treatment.
 Pulmonary physiotherapy
 Postural drainage
 Surgical procedures are required in
selective patients for drainage or
pulmonary resection.

29. COMPLICATIONS:
 Rare nowadays but include:
 Spread of infection to other lung
segments
 Bronchiectasis
 Empyema
 Bacteraemia with Metastatic infection
such as brain abscess.