Bronchiectasis is a condition defined as abnormal, irreversible dilation of the bronchi. It can be caused by primary infections, impaired mucus clearance, immunodeficiencies, hyperimmune responses, bronchial obstructions, autoimmune diseases, and developmental defects. The main pathogenesis involves bacterial infections destroying the bronchial wall structures through proteases and toxins. This leads to dilation of the bronchi and accumulation of thick, purulent material. Bronchiectasis can occur in several syndromes as well, including Kartagener's syndrome and Williams-Campbell syndrome. Tuberculosis is noted as a cause of predominantly upper lobe bronchiectasis, where the initial infection causes bronchial swelling and narrowing

1. B R O N C H I E C T A S I S
DR. SHRIRAM .S. SHENOY
RESIDENT, DEPT. OF RESPIRATORY MEDICINE,
SBKS MIRC.

2. AIM OF THIS PRESENTATION:
 DEFINITION OF BRONCHIECTASIS
 TYPES OF BRONCHIECTASIS
EITIOPATHOGENESIS OF BRONCHIECTASIS

3. DEFINITION:
• Bronchiectasis is a morphological term used
to describe abnormal irreversibly dilated and
often thick-walled bronchi.
• represents the end stage of a variety of
pathologic processes that cause destruction of
the bronchial wall and its surrounding
supporting tissues.

4. T Y P E S
OF
BRONCHIECTASIS

5. T Y P E S
• According to macroscopic morphology, three
types have been described, which also
represent a spectrum of severity
• A) CYLINDRICAL:

6. T Y P E S
• B) VARICOSE BRONCHIECTASIS

7. T Y P E S
• C) CYSTIC BRONCHIECTASIS:

8. T Y P E S
• D) TRACTION BRONCHIECTASIS

9. T Y P E S

10. T Y P E S
• BASED ON ANATOMIC DISRIBUTION:
• A) UPPER LOBE:

11. T Y P E S
• B) MIDDLE LOBE:

12. T Y P E S
• C) CENTRAL BRONCHIECTASIS:

13. T Y P E S
• D) LOWER ZONE:

14. AETIOPATHOGENESIS
OF
BRONCHIECTASIS

15. AETIOPATHOGENESIS:
• Bronchiectasis may be caused by
I) Primary infective insult
II) Primary impairment of mucous clearance
III) Immunodeficiency syndrome
a) Congenital b) acquired
IV) Hyperimmune response

16. AETIOPATHOGENESIS:
• V) Infection secondary to bronchial
obstruction
A) Intraluminal B) Extraluminal
VI) Autoimmune disease
VII) Inhalational/aspiration injury
VIII) Developmental defects
A) Structural B) Biochemical

17. PRIMARY INFECTIVE INSULT
• Bronchitis/bronchiolitis
• Pertussis
• Measles
• Adenovirus
• Pneumonia
• Tuberculosis

18. PRIMARY IMPAIRMENT OF MUCOUS
CLEARANCE
• Cystic fibrosis
CFTR mutations

19. • Primary ciliary dyskinesia
DNAI1, DNAH5, and DNAH11
• respiratory distress in neonates,
• recurrent respiratory tract infections
• Bronchiectasis
• Situs inversus, heterotaxia, infertility, and
hydrocephalus, singly or in various combinations.
• Noone et al. showed that bronchiectasis was
seen in 98 percent of cases of PCD.

20. IMMUNODEFICIENCY SYNDROME
• A) CONGENITAL:
• Common varied congenital immunodeficiency
• Selective immunoglobulin deficiency
• Functional immune deficiency
• B) ACQUIRED:
• Secondary hypogammaglobulinaemia
• Human immunodeficiency virus infection

21. HYPERIMMUNE RESPONSE
• Allergic bronchopulmonary mycoses

22. SECONDARY TO BRONCHIAL
OBSTRUCTION
A) Intraluminal
• Slow-growing tumour
• Aspirated foreign body
• B) Extraluminal:
• Lymphadenopathy
• Growth on the thoracic wall

23. AUTOIMMUNE DISEASE
• Inflammatory bowel disease
• Coeliac disease
• Systemic lupus erythematosus
• Rheumatoid disease
• Cryptogenic fibrosing alveolitis
• Primary biliary cirrhosis
• Thyroiditis
• Pernicious anaemia

24. INHALATIONAL/ASPIRATION INJURY
• Toxic fumes
• Gastric contents

25. DEVELOPMENTAL DEFECTS
• A) Structural
• Pulmonary agenesis
• Sequestrated segment
• Tracheobronchomegaly
• Bronchomalacia
• B) Biochemical
• a1-Antitrypsin deficiency

26. PATHOGENESIS
OF
BRONCHIECTASIS

27. • Micro-organisms such as staphylococcus
aureus , klebsiella, psuedomonas aeruginosa,
haemophilus influenzae etc.
protease and other toxins

28. Up-regulation of neutrophils
(Elastase and Matrix metallo-protinases)
Destruction of wall structures- cartilage,muscle,elastic tissue
and replaced by fibrous connective tissue
Dilatation of the bronchi leading to accumulation of the
thick pool of purulent material and occlusion due to
fibrous thickening
Increased vascularity due to enlargement of bronchial
arteries and increased anastomosis between bronchial
artery and pulmonary artery

30. PATHOGENESIS

31. SYNDROMES
a/w
BRONCHIECTASIS

32. SYNDROMES
 Kartagener’s syndrome (triad of situs inversus,
Bronchiectasis, and either nasal polyps or
recurrent sinusitis)
 Williams-Campbell syndrome (congenital
cartilage deficiency)
 Mounier-Kuhn syndrome (tracheo-
bronchomegaly)
 Swyer-James syndrome(unilateral hyperlucent
lung
 yellow nail syndrome(Hypoplastic lymphatics, pleural
effusion, yellow nails )

33. SYNDROMES
 Bare lymphocyte syndrome
 Nezelof syndrome (Thymic dysplasia with
normal immunoglobulins)
 Young’s Syndrome(bronchiectasis,
sinusitis,Azoospermia)

34. SWYER-JAMES SYNDROME

35. MOUNIER-KUHN SYNDROME

36. YELLOW NAIL SYNDROME

37. YELLOW NAIL SYNDROME

38. Tuberculosis as a Cause of Upper Lobe
Bronchiectasis
DAVID SALKIN,
M.D., San
Fernando
LEVEL OF
EVIDENCE:
A
This article
examines the
association
between
tuberculosis as a
cause of
predominantly
upper lobe
bronciectasis.
By serial bronchography
and bronchoscopy the
author has observed
clinically the formation
of bronchiectasis from
tuberculous bronchitis
in the lower lobes. It
was noted that there
was mural infiltration of
the diseased bronchus,
swelling of the
mucosa, and
pronounced decrease in
the size of the lumen, in
some cases to the point
of occlusion. Then, as
healing occurred, the
weakened bronchus
became
irregular and dilated

39. T H A N K Y O U ! !