Bronchiectasis is a chronic lung condition defined by abnormal dilation of the bronchi. It is commonly caused by previous lung infections but can also be due to other issues like airway obstruction, immune deficiencies, or genetic disorders. Patients present with excessive sputum production, chronic cough, recurrent lung infections, and sometimes blood in the sputum or cough. Diagnosis involves imaging tests like CT scans that show dilated bronchi. Treatment focuses on airway clearance and antibiotics to prevent infections. Surgery may be considered for severe cases or massive bleeding in the lungs.

1. BRONCHIECTASIS Zhiwen Zhu The 1 st affiliated hospital of Sun Yat-sen university, pulmonary department

2. BRONCHIECTASIS Definition Etiology Pathology Clinical presentation Diagnosis & differential diagnosis Treatment

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. Etiology Conditions associated with the development of bronchiectasis 1. Postinfection Bacterial pneumonia Tuberculosis Pertussis Measles Influenza

5. Etiology 2. Proximal airway obstruction Foreign body aspiration Benign airway tumors

8. 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.

9. Etiology 3.Abnormal host defense Ciliary dyskinesia ( Kartagener’s syndrome) Humoral immunodeficiency 4.Genetic disorders Cystic fibrosis α1- Antitrypsin deficiency 5.Others

10. Pathology Dilation and distortion of the bronchi Damage of airway epithelium Dilation and hyperplasia of blood capillary

14. Clinical presentation 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

15. 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

16. 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.

17. Evaluation 1.Roentgenographic studies The plain chest film: increased in size and number of bronchovascular markings (quiet nonspecific)

19. Evaluation 1.Roentgenographic studies Bronchography: (traditional gold standard)

21. 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.

24. 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.

28. Evaluation 2.Bronchoscopy Evaluating the proximal airways for lesions. Assessing the cause of hemoptysis Localizing the source of hemoptysis

30. Diagnosis Symptoms Sign reontgenographic fiding

31. 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.

32. Differential diagnosis Tuberculosis radiographic finding; sputum anti-fast smear Congenital pulmonary cyst multi thin wall cavities without infiltration around.

33. Treatment Medical management 1. Improving the drainage of airway 1) expectorant 2) bronchodilators 3) postural drainage

34. Anterior segment

35. Posterior segment of right upper lobe

36. Lower lobe

37. Treatment Medical management 1. Improving the drainage of airway 1) expectorant 2) bronchodilators 3) postural drainage 4) bronchoscopy

38. 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.

39. Treatment Surgical therapy Recurrent and refractory clinical symptoms are due to a focal area of disease involvement. Massive hemoptysis Management of hemoptysis

40. THANK YOU!!!