Bronchiectasis is a chronic lung condition characterized by permanent dilation of the bronchi. It has both congenital and acquired causes such as tuberculosis, pneumonia, cystic fibrosis, and primary ciliary dyskinesia. Patients experience chronic cough, sputum production, and recurrent lung infections. Diagnosis involves chest imaging such as CT scan. Treatment focuses on treating infections, clearing secretions, and surgery in severe cases. Surgical options include lung resection procedures such as lobectomy or pneumonectomy to remove diseased portions of the lung.

1. Bronchiectasis
-Ashish Rajendra Chordiya (501)
Department of Hospital Surgery
-Aleksandr Uleksandrovich Bezaltynnykh

2. Anatomy :

3. Definition:
• Bronchiectasis is a chronic, irreversible
dilation of the bronchi and bronchioles. Or
• Bronchiectasis is characterized by
permanent, abnormal dilation of one or
more large bronchi.

5. Etiology
• It has both: congenital and acquired causes.
• Acquired causes:
1) Tuberculosis
2) Pneumonia
3) Inhaled foreign bodies
4) Allergic bronchopulmonary aspergillosis (fungi) and bronchial tumours are the
major acquired causes of bronchiectasis.
5) AIDS.
• Infective causes:
1) Infections caused by Staphylococcus, Klebsiella or Bordetella pertussis.
2) Aspiration of ammonia and other toxic gases
3) Pulmonary aspiration
4) Alcoholism, drug use

6. • Congenital causes:
1) Cystic fibrosis
2) Primary ciliary dyskinesia (PCD) / Kartagener Syndrome
3) Primary immunodeficiencies
4) Alpha-1- antitrypsin deficiency
5) Mounier-Kuhn syndrome
• Pulmonary Diseases
1) Asthma
2) Bronchomalacia
3) COPD
4) Diffuse panbronchiolitis
5) Idiopathic pulmonary fibrosis

7. Classification:
• Based on Severity :
1) Fusiform/ Tubular / Cylindrical( most
common type, characterized by
development of mildly inflamed bronchi)
2) Varicose
3) Saccular/ cystic (characterized by severe,
irreversible ballooning of the bronchi)
• Based on Location:
1) Localized- confined to one lobe only
2) Generalized- Involves more than one lobe

8. 1) Cylindrical/ Tubular/ Fusiform :
• The luminal dilation is uniform
and the wall thickening is
smooth and there is failure of
normal tapering of the bronchi.

9. 2)Saccular/ Cystic:
• Most severe form of bronchiectasis.
The bronchi are severely dilated and
the bronchi end in a dilated thick
walled cyst.

10. 3) Varicose :
• The bronchi resemble like
varicose veins and also like
serpentine. The luminal dilation
is characterized by alternating
areas of dilation and
constriction, creating a beaded
appearance, and the wall
thickening is irregular.

11. Pathogenesis:

12. Clinical Manifestations:
• The hallmarks of Bronchiectasis are chronic cough with sputum production,
haemoptysis and recurrent pneumonias.
• Production of large quantities of purulent , foul- smelling, copious sputum.
The volume of sputum can be used for estimating the severity of disease.
1. Mild < 10mL
2. Moderate 10-150 mL
3. Severe >150mL
• Cough chronic, worse in morning.
• Haemoptysis : is due to rupture of thin walled vessels on the walls of
dilated bronchi. May vary from slight blood-streaked sputum to massive
fatal bleeding.

13. Clinical Manifestations (2) :
• Chest pain, which may be pleuritic, is present in 20-30% of patients.
• Dyspnoea, wheezing may occur.
• Systemic symptoms include fever, weight loss, anaemia, night sweats
and weakness.
• Exacerbation of infection (acute)- increased sputum volume, fever,
increased dyspnoea, wheezing, fatigue.
• Recurrent Pneumonias with chills and rigors, night sweats, increased
purulence of sputum, neutrophil leucocytosis in blood.

14. Physical findings:
• General examination may
reveal anaemia, clubbing of
digits (2-3%), fever, sinusitis
and halitosis.

15. Investigations/ Diagnostic evaluation:
• Blood picture shows anemia, raised ESR and leucocytosis indicating
suppuration.
• X-ray.
• In advanced and chronic cases, urine examination may show
proteinuria due to renal amyloidosis.
• Sputum studies (cultures ) should include Gram's stain, Ziehl-
Neelsen staining for acid-fast bacilli and culture and sensitivity. The
culture usually grows normal nasopharyngeal flora. Other commonly
grown organisms are Streptococcus pneumoniae. Haemophilus
influenzae and Pseudomonas aeruginosa in cystic fibrosis
• Chest radiograph is usually normal. Cystic or saccular bronchiectasis
may be diagnosed by multiple 1-2 cm cystic-appearing lesions with
or without fluid levels.

16. • Bronchography is rarely indicated presently.
• High-resolution computed tomography (CT) . Specific criteria include:-
Internal diameter of the bronchus is larger than that of its
accompanying vessel, or Bronchus fails to taper in the periphery of
the chest.
• Assessment of ciliary function may be done in a number of ways:
Assessment of the time taken for a small pellet of saccharin placed in
the anterior chamber of the nose to reach the pharynx, where patient
can taste it. Normally, it is less than 20 minutes. A prolongation of this
time to more than 60 minutes is seen in patients with ciliary
dysfunction . Measurement of ciliary beat frequency using biopsies
taken from the nose.

17. Treatment:
Goals of treatment:
• Treatment of the underlying problem
• Drainage procedures to improve clearance of tracheobronchial
secretions.
• Antibiotics for infections
• Reverse airflow obstruction
• Surgery.

18. Antibiotic therapy:
• Antibiotics (the choice of antibiotics should be accurately by the results of
sputum culture and drug sensitivity test)
• For Pseudomonas and MRSA- oral ciprofloxacin 500mg twice daily or IV
combination therapy with ceftazidime and aminoglycoside for two weeks
• Azithromycin 500mg thrice a week has shown to reduce excerbations and
sputum production.
• Severely ill patients with pneumonitis should be given parenteral
antibiotics including anti-pseudomonal coverage. 7-10 days course is
usually sufficient.
• For inhibition of inflammation: inhaled corticosteroid, macrolides (due to
immunomodulatory action)
• Bronchodilators to improve obstruction and aid clearance of secretions.

19. Surgery:
• Types of Lung surgery:
• Pneumonectomy
• Lobectomy
• Wedge resection
• Segmentectomy
• Sleeve lobectomy

20. Thoracotomy : Is a surgical procedure to gain access into the pleural
space of chest. to gain access to the thoracic organs, most commonly
the heart, the lungs, or the esophagus, or for access to the thoracic
aorta or the anterior spine.
• There are many different surgical approaches to performing a
thoracotomy. Some common forms of thoracotomies include:
• Median sternotomy provides wide access to the mediastinum and is
the incision of choice for most open-heart surgery and access to the
anterior mediastinum

21. Antero-lateral Thoracotomy :
• Anterolateral thoracotomy is
performed upon the anterior chest
wall; left anterolateral thoracotomy is
the incision of choice for open chest
massage, a critical maneuver in the
management of traumatic cardiac
arrest. Anterolateral thoracotomy,
like most surgical incisions, requires
the use of tissue retractors—in this
case, a "rib spreader" such as the
Tuffier retractor.

23. Pneumonectomy :
• A pneumonectomy is a surgical procedure to remove one lung.
• There are two basic types of pneumonectomy – simple pneumonectomy
and extrapleural pneumonectomy.
• A simple pneumonectomy, also called a standard pneumonectomy, is the
most common type of surgery used to remove an entire lung. During this
procedure, doctors only remove only the lung itself. It can be done on
either the right or the left lung.
• During an extrapleural pneumonectomy, doctors remove the affected lung
and portions of the diaphragm, pericardium, and pleura. Doctors typically
do it to treat malignant mesothelioma, which is a type of cancer that
affects the membrane that lines the chest cavity and surrounds the lungs
(the pleura).

25. Lobectomy
• A lobectomy is a surgical procedure where an
entire lobe of your lung is removed for a
variety of reasons that may include a lung
cancer diagnosis, infection, COPD or benign
tumors. There are three lobes of your right
lung and two lobes of your left lung. The
procedure includes either a few small
incisions (minimally invasive) or one longer
incision (thoracotomy) on the side of your
chest based on your particular diagnosis. With
either approach, along with a lobe, nearby
lymph nodes are also removed because of the
possible spread of disease or cancer.

26. • References
• www.nhs.uk
• www.mycleaveandclinic.org
• www.webmd.com
• www.msdmanuals.com