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03-18-2009, 10:38 AM
Bronchiectasis
Def: It’s abnormal persistent dilatation of the bronchi + suppurative infection.
Aetiology & Pathogenesis
Obstruction (stasis) à infection (destroys the bronchial wall )
Dilated & suppurated bronchioles
¯
Bronchiectasis

Causes à Bronchiectasis
I- Congenital à Kartagner’s à Dextrocardia
à Sinusitis or absent
frontal air sinuses.
à Congenital immune deficiency (infection)
Congenital polycystic Immotile cilia $
lung with ¯
extrapulmonary stasis
manifestation ¯
infection
II- Acquired

Obstruction Infection

e.g. lung abs. T.B., pneumonia
Complete Partial ¯
this destroys the
e.g. chronic bronchitis wall of bronchi
Lung collapse with
-ve pr around bronchioles
air entry with dilatation &

Traction on bronchioles ¯ air output infection


­ bronchial
pressure



Dilatation + Infection Dilatation
Sites 1- Bilateral & basal à areas of poor drainage
2- Apical on top of
¯ ¯
T.B. Friedlander pneumonia
This is called bronchiectasis sicca haemorrgica.
3- Rt. middle lobe $
The Rt. middle bronchus surrounded by L.Ns

¯

Infections leading to
L.Ns++

¯

Compress the bronchus (obstruction stasis)

¯

Infection
bronchiectasis
Caused by T.B., measles, whooping cough.
Complications

General Chest
• Haemoptysis • Lung abs
• toxemia • Pneumonia ( aspiration)
• Amyloidosis • Bronchitis (irritation)
• Septicemia • Pleurisy. & empyema
• Fibrosis
Septic shock • Core ulrnonale

N.B. Any infection As • lung abscess • Bronchiectasis.
• Pneumonia • Empyema
1- Leading to systemic complications
• Toxemia •Amyloidosis
• Septicemia •Septic shock
• Meningitis
2- Local complication:
Pleura Parenchyma Bronchi Marked ¯ Q2
¯ ¯ ¯ ¯
• pleurisy • pneumonia • Bronchiectasis • Core Pulmonale
• effusion • abscess (with bronchiectasis)
• empyema • fibrosis
• bronchopleural fistula
C/P Bronchiectasis is obstructive and suppurative lung disease.
Symptoms 1- FAHM
2- Cavitary à sputum
à foetid (bad odour)
à ­on stooping forwards
3- Haemoptysis (due to mucosal ulceration)
4- Dyspnea à due to fibrosis
due to obstruction
5- Chest pain à muscle Pain
à pleuritic
à pneumothorax (rare)
Signs General à toxemia
àclubbing
à edema

Core Pulmonale Hypoproteinemia Amyloidosis kid.







Inspection : movement¯ , retraction with fibrosis
Palpation : • TVF ­­ (bases)
• TVF ¯¯ (upper)
• Expansions ¯¯ bilateral.
Percussion: • Dullness in lower zone.
• Hyperresonance in upper zone
(compensatory emphysema).
Auscultation: • Obstruction à Rhonchi, harsh
vesicular breathing.
• Secretions à crepitations
(coarse cansonating crepitation)
• Cavitation à bronchial breathing + bronchophony
Investigations
1- Culture& Sensitivity
2- Plain x-ray à Honey comb.
3- Bronchography
4- Bronchoscopy
CT scan the best (can detect early bronchial dilatation)
Treatment
1- Postural drainage of sputum.
2- Antibiotic as lung abscess.
3- Expectorant &bronchodilator for bronchial drainage.
4- Surgery (lobectomy).
à Haemoptysts
Indications à persistent infection
à Localized lesion