The presence or absence of pleural effusion, thoracic lymphadenopathy (as defined by lymph node size of ≥ 10 mm in short-axis dimension), airway abnormalities (ie, airway wall thickening, bronchiectasis, and endoluminal secretions), and any underlying lung disease, including emphysema or fibrosis was also recorded. Those with the disease often get frequent lung infections. Upper lobe volume loss has worsened, with upward hilar retraction; overall lung volumes were not decreased because of the extensive airtrapping. N. Engl. ■ Provide a succinct differential diagnosis for the cause of bronchiectasis that is based on imaging patterns and distributions. Infection, aspiration, or another insult, such as bronchiolitis obliterans, can cause direct damage to the bronchial epithelium. 4, Current Pulmonology Reports, Vol. Wheezing and nail clubbing may also occur. Figure 19 Bronchiolitis obliterans with diffuse bronchiectasis several years after bilateral lung transplantation in a 67-year-old man. 129, No. (b) Axial reformatted maximum intensity projection CT image (soft-tissue window) at the same level shows extensive high-attenuating mucoid impaction of ectatic bronchi; high iron and manganese content of the fungal forms is thought to explain the high attenuation. 11, 30 October 2018 | Frontiers in Microbiology, Vol. 27, No. COPD – bullous emphysema Bullous emphysema manifests on a chest X-ray with areas of low density (black) with thinning of the pulmonary vessels, predominantly affecting the upper zones The lower part of the lungs may appear denser (whiter) in normal subjects because of overlying breast tissue, but in this individual the pulmonary vessels appear normal in this area Nodular opacities throughout the lungs correlate with areas of mucoid bronchial or bronchiolar impaction. 1, European Respiratory Journal, Vol. Emphysema and bronchiectasis in COPD patients with previous pulmonary tuberculosis: computed tomography features and clinical implications. In the emphysema-predominant group, 16.5% had bronchiectasis, while 10.3% of the non-emphysema-predominant group had the condition. The number of adults with cystic fibrosis has increased over the past few decades; in 1986, only 29.2% of patients with cystic fibrosis were adults, and in 2012, almost half the patients were older than 18 years. (a, b) Axial CT images from different anatomic levels in a 76-year-old man with a history of smoking show asymmetric volume loss and diffuse parenchymal hypoattenuation of the left lung, with accompanying bronchial wall thickening and cystic, cylindrical, and varicoid bronchiectasis. Histologically correlating with chronic rejection after lung transplantation, bronchiolitis obliterans is a major complication in long-term follow-up of patients after lung or heart-lung transplantation, affecting 56% of patients by 3 years after transplantation (55). 246 (3): 697-722. 60, No. These appearances often coexist in a single patient, and the overlapping range of morphologic features observed in most diseases associated with bronchiectasis necessitates the use of other characteristics, such as spatial distribution, to determine the cause. Oxford University Press, USA. Mosaic attenuation throughout the lungs is present; lower-attenuation regions represent airtrapping, and higher-attenuation areas represent normal lung. (c) Axial CT image shows the signet ring sign of bronchiectasis, with the dilated bronchus representing the “ring” and the adjacent smaller artery representing the “jewel” on the ring. Among the lung parenchyma changes, a combination of bronchiectasis and emphysema is unique to this syndrome. The main clinical manifestation of bronchiectasis is chronic productive cough (1). The authors will review various causes of bronchiectasis, including common causes, such as recurrent infection or aspiration, and uncommon causes, such as congenital immunodeficiencies and disorders of cartilage development. Viewer, http://www.cff.org/UploadedFiles/research/ClinicalResearch/PatientRegistryReport/2012-CFF-Patient-Registry.pdf, Thoracic Manifestations of Rheumatoid Arthritis, Bronchiectasis Revisited: Imaging-Based Pattern Approach to Diagnosis, National Jewish Health classical pulmonary radiology case reports: imaging features of allergic bronchopulmonary aspergillosis, The Immune Mechanisms of Lung Parenchymal Damage in Tuberculosis and the Role of Host-Directed Therapy. (c) Coronal reformatted volume-rendered thick-slab CT image shows extensive bronchiectasis and high-attenuating mucous plugging in the central upper lobes. Definition; COPD . ABPA: glove-finger shadow due to mucoid impaction in central bronchiectasis in a patient with asthma. 1992;31 (10): 691-3. Of note, neutrophils release elastases, proteases, and free radicals, leading to airway damage. some people (rare cases) have a condition called … Conditions that may mimic cystic bronchiectasis include 8: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. In some cases, chronic prophylactic administration of antibiotics may be required. 50, No. Bronchiectasis as a diagnostic term has been misused as a catch-all for several types of pulmonary suppuration. 4, 6 June 2018 | QJM: An International Journal of Medicine, Vol. Bronchiectasis News Today is strictly a news and information website about the disease. (c) Axial CT image obtained several months after recovery in a 49-year-old woman with prior intensive care unit admission for pneumonia and acute respiratory distress syndrome shows anterior-predominant architectural distortion with bronchiectasis in the right middle lobe and lingula, a typical distribution for post-acute respiratory distress syndrome–related fibrosis. If the address matches an existing account you will receive an email with instructions to reset your password. Lonni S, Chalmers JD, Goeminne PC, McDonnell MJ, Dimakou K, De Soyza A, Polverino E, Van de Kerkhove C, Rutherford R, Davison J, Rosales E, Pesci A, Restrepo MI, Torres A, Aliberti S. Etiology of Non-Cystic Fibrosis Bronchiectasis in Adults and Its Correlation to Disease Severity. Multiple studies have revealed that computed tomography (CT) findings such as bronchiectasis, mucous plugging, and airway wall thickening could predict deterioration in patients more reliably than the traditional method of follow-up pulmonary function tests (3,4). Bronchiectasis is a disease in which there is permanent enlargement of parts of the airways of the lung. (b) Chest radiograph obtained 5 years later shows that bronchiectasis has progressed, with parallel linear opacities extending along the central upper lobes, representing the tram-track appearance of bronchiectasis. More recently, volumetric thin-section CT has become popular for the assessment of diffuse lung disease, with helical CT acquisitions generally at 1–1.25-mm section thicknesses. (2007) ISBN:0781757657. (b) Coronal reformatted CT image shows corresponding dilated bronchi with thickened walls and cylindrical and cystic bronchiectasis. (b) Coronal reformatted minimum intensity projection CT image shows left lower lobe bronchial occlusion due to the endobronchial component of the tumor, with accompanying cystic and varicoid left lower lobe bronchiectasis. Tree-in-bud nodules indicate the diffuse bronchiolitis that typically occurs in cystic fibrosis. Radiol. Although bronchiectasis in the context of immunodeficiency was initially thought to be a direct result of recurrent infection, it has more recently been shown in acquired immunodeficiency syndrome–associated airway disease that bronchial dilatation can be present at CT in the absence of documented prior infection; this finding suggests a direct compromise of the pulmonary immune system by human immunodeficiency virus (21). 2009;193 (3): W158-71. Bronchiectasis is a predominant imaging finding in cystic fibrosis, with important clinical implications. •Airflow obstruction in bronchiectasis is linked to evidence of intrinsic disease of the small and medium airways (bronchial wall thickness) and not to bronchiectatic abnormalities, emphysema or retained endobronchial secretions (Roberts et al. Bronchiectasis represents both an important potential cause of morbidity (usually associated with recurrent infection and related complications) and a valuable indicator of underlying pulmonary disease. When accompanied by acute or recent aspiration, centrilobular ground-glass and tree-in-bud nodules are common in the bronchocentric areas of the lower lobes and the dependent upper lobes. After lung transplantation, patients are monitored with pulmonary function testing, bronchoscopy, and transbronchial biopsy, the latter of which can reveal bronchiolitis obliterans at the earliest time (55). Bronchiectasis may occur as a result of various pathologic processes and thus may be a feature of a number of different lung and airway diseases (1,… However, in postprimary tuberculosis, previously contained primary infection becomes active infection usually during a period of immunosuppression, malnutrition, or other debilitation. Kartagener syndrome refers to the clinical combination of situs inversus, chronic sinusitis, and bronchiectasis in a subset of patients with ciliary dyskinesia. Bronchiolitis Obliterans.—Bronchiolitis obliterans is clinically defined by a decrease in forced expiratory volume in 1 second by more than 20% in the presence of airflow obstruction at pulmonary function testing (54). Chest x-rays are usually abnormal but are inadequate in the diagnosis or quantification of bronchiectasis. J. Med. Airtrapping secondary to airway collapse in the context of excessively compliant bronchial walls can also be seen (51). Mcguinness G, Naidich DP, Leitman BS et-al. 8, No. Acute exacerbations of bronchiectasis are associated with increased mortality, with decreased forced expiratory volume in 1 second and a history of smoking associated with poor outcomes (7); patients with chronic obstructive pulmonary disease are prone to prolonged exacerbations (8). According to macroscopic morphology, three types have been described, which also represent a spectrum of severity 8: According to one study, the relative prevalence of bronchiectatic changes were 14: Additionally, bronchiectasis can result from the traction of fibrotic lung surrounding an airway. Lippincott Williams & Wilkins. (b) Coronal reformatted minimum intensity projection CT image shows extensive lower lobe bronchiectasis with cylindrical morphologic features, a distribution and appearance that can be seen in cases of chronic aspiration. Types. However, of importance, the normal ratio can reach up to 1.3:1 in some bronchi in healthy control subjects, and the bronchoarterial ratio can increase in older patients without clinical evidence of airways disease (23,24). (c) Axial CT image obtained several months after recovery in a 49-year-old woman with prior intensive care unit admission for pneumonia and acute respiratory distress syndrome shows anterior-predominant architectural distortion with bronchiectasis in the right middle lobe and lingula, a typical distribution for post-acute respiratory distress syndrome–related fibrosis. Shannon A. Novosad and Alan F. Barker, both of Oregon Health and Science University, in Chronic Obstructive Pulmonary Disease and Bronchiectasis, published in Current Opinion in Pulmonary Medicine. Lippincott Williams & Wilkins. bronchiectasis and pulmonary resistance (Pande, et al. McGuinness G, Naidich DP, Garay S, Leitman BS, McCauley DI. Naidich DP, Srichai MB, Krinsky GA. Computed tomography and magnetic resonance of the thorax. Author information: (1)Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing. The main symptom is breathlessness. 52, No. The classic diagnostic triad in patients with cystic fibrosis includes an abnormal sweat chloride test result and manifestations of pulmonary and pancreatic disease (27). Pulmonary vasculature appears ill-defined, thought to represent peribronchovascular fibrosis 8,9. Minimum intensity projection images are particularly useful for showing winding connected tubular structures. Habesoglu MA, Ugurlu AO, Eyuboglu FO. (d) Coronal reformatted minimum intensity projection CT image shows bilateral symmetric upper lobe cylindrical and varicoid bronchiectasis. The early exudative phase of acute respiratory distress syndrome is usually associated with patchy or diffuse ground-glass pulmonary opacities. Tree-in-bud nodules indicating bronchiolitis and airtrapping are also common (51). 54, No. Varicoid traction bronchiectasis is a frequent finding in pulmonary fibrosis; the segmental, subsegmental, and smaller bronchi are the most severely affected (19) (Fig 11). (a) Axial CT image shows extensive ground-glass opacity in the lower lungs, with cylindrical and varicoid bronchiectasis and bronchial wall thickening. Minimum intensity projection imaging is another effective way to evaluate bronchiectasis, to discern honeycombing or cyst formation from bronchiectasis; for the latter, minimum intensity projection images show winding, connected, and distorted airways. (c, d) Axial (c) and coronal reformatted (d) minimum intensity projection CT images obtained 2 years later (at 26 years of age) show extensive cystic and varicoid bronchiectasis in the upper lobes. T Hill A, L Sullivan A, D Chalmers J, De Soyza A, Stuart Elborn J, Andres Floto R, Grillo L, Gruffydd-Jones K, Harvey A, S Haworth C, Hiscocks E, R Hurst J, Johnson C, Peter Kelleher W, Bedi P, Payne K, Saleh H, J Screaton N, Smith M, Tunney M, Whitters D, Wilson R, R Loebinger M. British Thoracic Society Guideline for bronchiectasis in adults. Westcott JL, Cole SR. Postmortem examination of the lungs of 12 patients with end-stage pulmonary fibrosis revealed the frequent (nine of 12) presence of bronchiectasis. Transient obstruction may lead to infection and worsening bronchiectasis. Many COVID‐19 patients are often infected with germs causing pneumonia – and that this in turn can lead to lung damage of the emphysema type. However, many individuals with a history of acute respiratory distress syndrome have persistent bronchial dilatation, indicating that the disease has progressed to fibrosis with true bronchiectasis (irreversible dilatation) (Fig 9c). At CT, cystic bronchiectasis is limited to the mid-order subsegmental airways, specifically the fourth- to sixth-order bronchi (51) (Fig 16). Note the normal caliber of the trachea and proximal bronchi, an appearance compatible with Williams-Campbell syndrome. Ectatic bronchi lack the smooth progressive tapering of normal bronchi and may even increase in diameter as they extend outward toward the lung periphery. Figure 5a Sarcoidosis in a 35-year-old woman. 8. Javidan-Nejad C, Bhalla S. Bronchiectasis. Elevation of the left hemidiaphragm and leftward mediastinal shift accompany the severe left lower lobe volume loss. Increased mucus secretion, decreased mucociliary clearance, airway wall thickening, and transient collapse of weakened dilated airways may contribute to the chronic obstruction that characterizes bronchiectasis; enlarged subepithelial lymph follicles or peribronchial and hilar lymph nodes with resulting bronchial narrowing may also contribute to the obstruction (1,18). Bronchiectasis (BE) is associated with chronic obstructive pulmonary disease (COPD), but emphysema and small airways disease, main pathologic features of COPD, have been sparsely studied in BE. 85 (307-308): 875-82. Areas of low attenuation represent airtrapping. 2010;20 (1): 85-102. However, the nonclassic category of infection is associated with mild to moderate cylindrical bronchiectasis and centrilobular nodules with a predilection for the right middle lobe and lingula (37). 8, No. 69, No. After completing this journal-based SA-CME activity, participants will be able to: ■ Recognize key findings at imaging to facilitate the diagnosis of bronchiectasis. The typical symptoms at presentation include cough and dyspnea in patients with significant endobronchial and pulmonary parenchymal involvement. (b) Axial CT image shows extensive cystic bronchiectasis, pronounced bronchial wall thickening with areas of mucoid bronchial impaction, and a moderate mosaic attenuation pattern indicating areas of airtrapping due to small-airways disease. α1-Antitrypsin Deficiency.—Another less common cause of bronchiectasis is α1-antitrypsin deficiency. For this journal-based SA-CME activity, the authors, editor, and reviewers have disclosed no relevant relationships. (2015) Annals of the American Thoracic Society. Bronchiectasis is defined as irreversible dilatation of a portion of the bronchial tree. (a) Coned-down posteroanterior radiograph in a 67-year-old man with tracheobronchomegaly shows a large tubular lucency projecting over the midline upper mediastinum, a finding representative of a severely dilated trachea. 4, No. {"url":"/signup-modal-props.json?lang=us\u0026email="}. Alternately, less than 32% airtrapping had a high negative predictive value for the condition (57). Key Difference – Bronchitis vs Bronchiectasis Both bronchitis and bronchiectasis are respiratory disorders whose pathogenesis is significantly contributed by chronic smoking. Figure 2a Three basic morphologic types of bronchiectasis that are recognized at CT (many patients have a combination of these). Figure 5b Sarcoidosis in a 35-year-old woman. Despite progress in the treatment of symptoms and prevention of acute exacerbations, few advances have been made to ameliorate disease progression or affect mortality. Emphysema. In patients with α 1 -antitrypsin deficiency who develop bronchiectasis, the distribution tends to follow the emphysematous changes, with greater severity in the lower lungs ( 49 ). Bronchiectasis is irreversible regional or diffuse bronchial dilatation usually resulting from a repeated pattern of infection, inflammation, and injury. From the Department of Radiology and Imaging Sciences, Division of Cardiothoracic Imaging (B.M., T.S.H., B.P.L. 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