Bronchiectasis is an inflammatory condition of the bronchus present in the lungs. It is caused because of a preexisting lung infection. It was first identified by Laennec in 1819. The symptoms associated with it are categorized by persistent exacerbation. There are three predominant forms of bronchiectasis - cylindrical, varicose and cystic respectively. Bronchiectasis is one of the causes associated with chronic obstructive pulmonary disease. Bronchiectasis occurs at a specific location initially and then the locus of the inflamed tissue progresses to other parts.Bronchiectasis is caused by damage to the bronchiolar tissue. The inflammation weakens the elasticity of the respective tissue causing muscular damage and eventually weakens the bronchial walls. A scarred tissue is the evidence of its onset and this leads to conditions such as edema and secondary microbial infections which further damage the parenchymatic tissue of the bronchus. In case of cylindrical bronchiectasis the bronchus becomes enlarged because of the inflammation and appears cylindrical. It is also called tram track appearance and signet ring appearance referring to the dilation caused in the bronchus. Radiological findings of cylindrical bronchiectasis indicate that the diameter of the luminary air way becomes more than the vessels adjacent to it.
The secondary microbial infections in bronchiectasis are caused by atypical forms of Mycobacteria, Klebsiella pneumonia, Staphylococcus species predominantly aureus and also plasma. Pertussis, Respiratory syncytial and influenza viruses also cause much damage in the form of secondary infections. In some cases, aspirations have also been reported to cause bronchiectasis especially associated with food particles. In addition to these, bronchiectasis can occur because of several acquired and congenital reasons such as Young's syndrome, alpha 1 antitrypsin deficiency and allergic bronchitis associated with aspergillosis.
Diagnosis of Bronchiectasis
Many factors contribute to its occurrence which also includes lifestyle patterns such as stress and smoking. These factors damage the bronchial tissue thus leading to the onset of the obstructive disease. Patients suffering from bronchiectasis of any form suffer symptoms such as purulent cough which persists for a long time, low grade fever, weight loss in case associated with tuberculosis, edema and fatigue.
Radiology helps in identifying the type of bronchiectasis which can be clinically correlated with the associated microbial infection. Specificity of cylindrical bronchiectasis is identified by the presence of dilated bronchus (increased luminary space) with inflammation. Patient history examination is also necessary to identify congenital pulmonary abnormalities.
Treatment of Bronchiectasis
Bronchiectasis patients are treated with standard anti-inflammatory and antimicrobial regimens. The prognosis is closely associated with change of lifestyle. Complications include pneumothorax, persistent hospital acquired pneumonia, antimicrobial resistance, lung abscesses and emphysema.
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Bibliography / Reference
Collection of Pages - Last revised Date: April 6, 2020