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BRONCHIECTASISBRONCHIECTASIS
Zhiwen Zhu
The 1st
affiliated hospital of Sun Yat-
sen university, pulmonary
department
BRONCHIECTASIS
 Definition
 Etiology
 Pathology
 Clinical presentation
 Diagnosis & differential diagnosis
 Treatment
Definition
 Bronchiectasis is a condition anatomically
defined by chronic, irreversible dilation
and distortion of the br...
Etiology
Conditions associated with the development of
bronchiectasis
1. Postinfection
• Bacterial pneumonia
• Tuberculosi...
Etiology
2. Proximal airway obstruction
• Foreign body aspiration
• Benign airway tumors
Etiology
2. Proximal airway obstruction
• Middle lobe syndrome
Extrinsic compression by enlarged lymph nodes
of the right ...
Etiology
3.Abnormal host defense
• Ciliary dyskinesia ( Kartagener’s syndrome)
• Humoral immunodeficiency
4.Genetic disord...
Pathology
 Dilation and distortion of the bronchi
 Damage of airway epithelium
 Dilation and hyperplasia of blood capil...
Clinical presentation
1. The production of large quantities of
purulent and often foul-smelling sputum.
The volume of sput...
Clinical presentation
2. Chronic cough
3. Hemoptysis:
 Frequent
 More commonly in dry variety
 Usually mild (blood stre...
Clinical presentation
Physical finding
 Early phases or dry variety: normal
 Severe or secondary infection: persisting
c...
Evaluation
1.Roentgenographic studies
• The plain chest film: increased in size
and number of bronchovascular markings
(qu...
Evaluation
1.Roentgenographic studies
• Bronchography: (traditional gold
standard)
Evaluation
CT or HRCT: high sensitivity and
specificity
Train track sign: the bronchial wall is
thicken and visible; the ...
Evaluation
CT or HRCT: high sensitivity and
specificity
Diamond ring sign: dilated bronchi appear
as ring structures with...
Evaluation
2.Bronchoscopy
 Evaluating the proximal airways for
lesions.
 Assessing the cause of hemoptysis
 Localizing ...
Diagnosis
 Symptoms
 Sign
 reontgenographic fiding
Differential diagnosis
Differentiate from:
• Chronic bronchitis
No recurrent hemoptysis; CT scan
• Lung abscess
X-ray/CT: ...
Differential diagnosis
• Tuberculosis
radiographic finding; sputum anti-fast
smear
• Congenital pulmonary cyst
multi thin ...
Treatment
 Medical management
1. Improving the drainage of airway
1) expectorant
2) bronchodilators
3) postural drainage
Anterior segment
Posterior segment of right
upper lobe
Lower lobe
Treatment
 Medical management
1. Improving the drainage of airway
1) expectorant
2) bronchodilators
3) postural drainage
...
Treatment
 Medical management
2. Antibiotic
 The choice of antibiotics should be
accurately by the results of sputum cul...
Treatment
 Surgical therapy
1. Recurrent and refractory clinical
symptoms are due to a focal area of
disease involvement....
4bronchiectasis 100510232428-phpapp01 (1)
4bronchiectasis 100510232428-phpapp01 (1)
4bronchiectasis 100510232428-phpapp01 (1)
4bronchiectasis 100510232428-phpapp01 (1)
4bronchiectasis 100510232428-phpapp01 (1)
4bronchiectasis 100510232428-phpapp01 (1)
4bronchiectasis 100510232428-phpapp01 (1)
4bronchiectasis 100510232428-phpapp01 (1)
4bronchiectasis 100510232428-phpapp01 (1)
4bronchiectasis 100510232428-phpapp01 (1)
4bronchiectasis 100510232428-phpapp01 (1)
4bronchiectasis 100510232428-phpapp01 (1)
4bronchiectasis 100510232428-phpapp01 (1)
4bronchiectasis 100510232428-phpapp01 (1)
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4bronchiectasis 100510232428-phpapp01 (1)

  1. 1. BRONCHIECTASISBRONCHIECTASIS Zhiwen Zhu The 1st affiliated hospital of Sun Yat- sen university, pulmonary department
  2. 2. BRONCHIECTASIS  Definition  Etiology  Pathology  Clinical presentation  Diagnosis & differential diagnosis  Treatment
  3. 3. 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.
  4. 4. Etiology Conditions associated with the development of bronchiectasis 1. Postinfection • Bacterial pneumonia • Tuberculosis • Pertussis • Measles • Influenza
  5. 5. Etiology 2. Proximal airway obstruction • Foreign body aspiration • Benign airway tumors
  6. 6. 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.
  7. 7. Etiology 3.Abnormal host defense • Ciliary dyskinesia ( Kartagener’s syndrome) • Humoral immunodeficiency 4.Genetic disorders • Cystic fibrosis • α1- Antitrypsin deficiency 5.Others
  8. 8. Pathology  Dilation and distortion of the bronchi  Damage of airway epithelium  Dilation and hyperplasia of blood capillary
  9. 9. 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
  10. 10. Clinical presentation 2. Chronic cough 3. 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
  11. 11. Clinical presentation Physical finding  Early phases or dry variety: normal  Severe or secondary infection: persisting crackling rales in the same part of lung  Later stage: digital clubbing, emphysema, and cor pulmonale.
  12. 12. Evaluation 1.Roentgenographic studies • The plain chest film: increased in size and number of bronchovascular markings (quiet nonspecific)
  13. 13. Evaluation 1.Roentgenographic studies • Bronchography: (traditional gold standard)
  14. 14. 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.
  15. 15. 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.
  16. 16. Evaluation 2.Bronchoscopy  Evaluating the proximal airways for lesions.  Assessing the cause of hemoptysis  Localizing the source of hemoptysis
  17. 17. Diagnosis  Symptoms  Sign  reontgenographic fiding
  18. 18. 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.
  19. 19. Differential diagnosis • Tuberculosis radiographic finding; sputum anti-fast smear • Congenital pulmonary cyst multi thin wall cavities without infiltration around.
  20. 20. Treatment  Medical management 1. Improving the drainage of airway 1) expectorant 2) bronchodilators 3) postural drainage
  21. 21. Anterior segment
  22. 22. Posterior segment of right upper lobe
  23. 23. Lower lobe
  24. 24. Treatment  Medical management 1. Improving the drainage of airway 1) expectorant 2) bronchodilators 3) postural drainage 4) bronchoscopy
  25. 25. Treatment  Medical management 2. Antibiotic  The choice of antibiotics should be accurately by the results of sputum culture and drug sensitivity test.  Empirical therapy ---antipseudomonal antibiotics.
  26. 26. 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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