Diagnosis and Imaging of Bronchiectasis.ppt

1. Radiological manifestation of
bronchiectasis
Dr. Saifurahman Safi
Feb, 2024

2. Bronchiectasis:
• Bronchiectasis is a chronic inflammatory lung disease
characterized by irreversible dilation of the bronchi,
the airways that carry air to and from the lungs.
• This dilation can lead to a variety of symptoms,
including chronic cough, sputum production, shortness
of breath, and recurrent respiratory infections

3. 1. Epidemiology
• approximately 40 /100.000 (est.)
• more in women
• more in elderly population
• more in societies with pure access to health care

4. 2. Etiologies
infection of the airway + susceptibility
Susceptibility:
1.airway obstruction
2.defect in host defence
3.impaired drainage
4.other

5. 2. Etiologies – airway obstruction
Innate:
• bronchomalacia
• tracheobronchomegaly
• bronchial cyst
• ectopic bronch
• pulmonary sequestration
• Yellow nail sy.
Acquired
• foreign body aspiration (children, ...)
• (benign) tumour
• hilar adenopathy (TBC, sarcoidosis)
• chronic bronchitis
• polychondritis
• mucus impaction (ABPA, ...)

6. 2. Etiologies – defect in host defense
Innate:
• IgG deficiency (agammaglobulinemia, subclass deficiency,...)
• IgA deficiency
• chronic granulomatous disease (dysf. NADPH oxidase)
Acquired
• AIDS / HIV
• malnutrition

7. 2. Etiologies – impaired drainage / other
Impaired drainage:
• CF
• Young’s sy.
• PCD
• Kartagener’s sy.
Other:
• RA, Sjoegren’s sy
• alpha – 1 antitrypsin deficiency
• GIT disorders (UC, Crohn, GERD)
• infections in childhood (pertussis, measles, bacterial pneumonia, TBC,
adenovirus, ...)
• inhalation of toxic fumes and dusts (NO2, lipoid pneumonia, acids,...)
Kartagener’s sy.

8. 3. Clinical findings
1. cough and mucopurulent sputum - months / years
2. dyspnea, wheezing, chest pain
3. recurrent “bronchitis” and frequent antibiotic courses
Cough 98%
Daily sputum 78%
Rhinosinusitis 73%
Dyspnea 62%
Hemoptysis 27%
Pleurisy 20%
Crackles 75%
Wheezing 22%
Digital clubbing 2%
*King PT et al. Respir Med 2006; 100: 2183.

10. 4. Diagnosis
The purpose of evaluation:
1. radiographic confirmation
2. potentially treatable causes?
3. functional assessment
Evaluation:
• history / examination
• laboratory testing
• radiographic imaging
• pulmonary function testing
• other testing

11. 4. Diagnosis – laboratory testing
1. CBC, differential BC
2. immunoglobulin quantitation (levels of IgG, IgM, IgA)
3. sputum culture (bact. / TBC / fungi)

12. Radiological Imaging
 Radiological imaging plays an
important role in the diagnosis and
assessment of bronchiectasis.
 The most commonly used imaging
modalities are chest X-ray and
high-resolution computed
tomography (HRCT).

13.  Chest X-ray Findings
 Chest X-rays are often the first imaging modality used
to evaluate for bronchiectasis. However, they may
not always show subtle changes or early stages of the
disease.

14. Common findings on chest X-
rays include:
 Tram-track opacities: These linear
opacities represent thickened bronchial
walls.

18.  Air-fluid levels: These represent collections of air and fluid within
dilated bronchi, often seen in cystic bronchiectasis.

19.  Bronchus sign: This refers to the
visualization of a dilated bronchus within
1 cm of the pleural surface.

23. High-Resolution Computed
Tomography (HRCT)
 HRCT is the gold standard imaging modality for
diagnosing and assessing bronchiectasis.
 It provides excellent detail of the airways and
surrounding tissues, allowing for more precise
evaluation of the disease extent and severity.
 Common HRCT findings include:

24.  Cylindrical bronchiectasis: Dilated
bronchi without saccular or cystic
changes.

25.  Cystic bronchiectasis: Dilated bronchi with
saccular or cystic changes.

26.  Bronchial wall thickening: Thickening of the
bronchial walls due to inflammation and fibrosis.

27.  Bronchoarterial ratio: This measures the ratio of the diameter of
a bronchus to the adjacent pulmonary artery branch. A ratio
greater than 1.5 is suggestive of bronchiectasis.

28.  Signet ring sign: This refers to the
appearance of a dilated bronchus
surrounding a pulmonary artery,
resembling a signet ring.

32. Other Imaging Modalities
 In some cases, other imaging modalities may be used to
further evaluate bronchiectasis or assess complications.
These include:
 Bronchoscopy: This procedure involves inserting a thin
tube with a camera into the airways to visualize the
inside of the bronchi and collect samples for analysis.

33. CONT...
 Diffusing capacity of the lungs for carbon monoxide
(DLCO): This test measures the ability of the lungs to
transfer oxygen from the air to the bloodstream.

34. Conclusion
 Radiological imaging plays a crucial role
in diagnosing and managing
bronchiectasis.
 Chest X-rays are often the first imaging
modality used, but HRCT is the gold
standard for detailed evaluation of the
disease extent and severity.
 Other imaging modalities may be used to
further assess the condition or
complications.
 Early diagnosis and appropriate
management can help improve quality of
life and reduce complications in patients
with bronchiectasis.

35. THANK YOU