1. Bronchiectasis
Permanent abnormal dilatation
of bronchi, due to recurrent
infection or inflammation

2. Causes
 Lung infections- pneumonia, TB etc.
 Cystic fibrosis
 Intrinsic or extrinsic bronchial compression-
foreign body, tumor, LN
 Impaired mucociliary clearance-
dyskinetic ciliary syndromes-
e.g. Kartagener’s, with sinusitis & infertility
 Immunodeficiency- congenital or acquired

3. Manifestations
 Recurrent or chronic cough
 ± copious purulent sputum production-
uncommon with upper lobe involvement
 Hemoptysis- streaking or frank
 Recurrent fever
 Dyspnea
 Wheezes & crepitations
 Clubbing, cyanosis, hypoxemia in severe
disease

4. Investigations
 Dx- HRCT- high resolution CT chest
 Other-
 Leukocytosis
 Raised ESR
 Hypoalbuminemia
 PFT- obstructiverestrictive pattern
 ABG- hypoxemia
 CxR- cystic lesions, tram-tracks, grape clusters
 Bronchoscopy- for endobronchial compression
 Sputum culture- if required

5. Treatment
 Empirical antibiotics for acute exacerbations
 Inhaled aerosolized aminoglycosides to
prevent Pseudomonas colonization
 Chest percussion & gravity drainage of
secretions
 Bronchodilators, if required
 Quit smoking, good nutrition, graded exercise
 Arterial embolization for hemoptysis, if reqd.
 Surgery for localized troubling disease

6. Lung abscess
 Secondary to aspiration
 Predisposing factors-
 Altered sensorium, seizures
 Alcoholism, drug abuse
 General anesthesia
 ET or NG tube
 Poor dentition & oral hygiene
 Polymicrobial- anaerobic + other bacteria
 Site- posterior segment of upper lobe,
apical segment of upper/lower lobes

7. Evaluation
 s/s-
 Fever, malaise, weight loss
 Cough ± foul-smelling expectoration
 Poor dentition
 Ix-
 CxR- thick-walled cavity with air-fluid level,
surrounded by consolidation
(Thin-walled cavity- Staph., Klebsiella, Pseudomonas pneumonia)
 Bronchoscopy- for non-resolving abscess
 DDx- TB, cancer, mycosis, infarction,
Wegener’s granulomatosis

8. Treatment
Clindamycin or Co-amoxyclav,
till resolution of cavity