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  • • Defined as abnormal dilation of bronchi

    • Denotes clinical syndrome marked by:

    • -Chronic dilation of bronchi

      -Paroxysmal cough producing mucopurulent sputum

      -Recurrent pulmonary infections

    • 2 main types

    • -Saccular: Follows most infections and bronchial obstruction

      -Cylindric: Associated with post-TB bronchiectasis

    • Mixed or varicose: Third type; alternates saccular and cylindrical areas

    • Involves second to fourth order branches

    • Congenital often bilateral bronchiectasis

    • TB/granulomatous disease more often unilateral, or bilateral but limited to upper lobes

    • Pyogenic/pneumonias result in bronchiectasis of lower lobes, lingula

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Epidemiology

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  • • Congenital disease can cause bronchiectasis

    • -Kartagener syndrome

      -Cystic fibrosis, Williams-Campbell syndrome

      -Mounier-Kuhn syndrome, immunoglobulin deficiency

      1-Antitrypsin deficiency

    • Most cases are not congenital but caused by infection and bronchial obstruction

    • -Pertussis

      -Measles

      -Influenza

      -TB

      -Bronchopneumonia

    • Repeated bouts or single severe pneumonia can causes bronchiectasis

    • Foreign bodies, endobronchial neoplasms, hilar lymphadenopathy can lead to bronchiectasis

    Common pathogens: H influenza, S aureus, K pneumoniae, E coli

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Symptoms and Signs

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  • • Recurrent febrile episodes

    • Chronic or intermittent cough producing foul-smelling sputum (up to 500 mL/d)

    • Hemoptysis (about 50% of patients)

    • Advanced disease indicated by increased sputum production, fever, dyspnea, anorexia, fatigue, and weight loss

    • History of sinus problems, infertility, or family history may indicate inherited disease

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Imaging Findings

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  • High-resolution chest CT: Documents bronchial dilation

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Rule Out

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  • • Obstruction from neoplasm or foreign body

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  • • Culture for common pathogens (E coli, Klebsiella, Staph, H influenza)

    • Culture for mycobacteria, fungi, Legionella

    Chest CT scan: Required preoperatively

    • Bronchoscopy with bronchoalveolar lavage (BAL) for culture

    • Bronchogram may be needed prior to operation

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  • • In most cases, conservative medical treatment is sufficient

    • Broad-spectrum antibiotics, bronchodilators, humidification, expectorants, mucolytics, and postural drainage

    Continued infection: Bronchoscopy with BAL for culture

    • Influenza and pneumococcal vaccines may be needed

    • Inhaled antibiotics (gentamicin or tobramycin) may help control infection

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Surgery

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  • Goals: Remove all active disease, preserve functioning lung as much as possible

    • Maintain clear airway devoid of mucopurulent secretions or blood

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Indications

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  • • Criteria for failure of medical therapy include:

    • -Localized disease and completely resectable

      -Adequate pulmonary reserve

      -Irreversible process

      -Significant symptoms despite medical treatment

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Complications

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  • • Hemoptysis, lung, and brain abscess; empyema; respiratory failure; death

    • All complications decreased since anti-TB medications emerged

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Prognosis

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  • Local disease: 80% success with surgery

    Diffuse disease: 36% surgical success

    Prognostic factors: Unilateral disease in basal segments, young age, absence of sinusitis or rhinitis, history of pneumonia, no airway obstruction

    Morbidity: 3-5%; mortality < 1%

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Prevention

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  • • Long-term antibiotic therapy may be needed for prophylaxis (sulfamethoxazole-trimethoprim, ciprofloxacin, etc)

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References

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