Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • 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 +++ Epidemiology + • Congenital disease can cause bronchiectasis-Kartagener syndrome-Cystic fibrosis, Williams-Campbell syndrome-Mounier-Kuhn syndrome, immunoglobulin deficiency-α1-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 +++ Symptoms and Signs + • 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 +++ Imaging Findings + • High-resolution chest CT: Documents bronchial dilation +++ Rule Out + • Obstruction from neoplasm or foreign body + • 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 + • 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 +++ Surgery + • Goals: Remove all active disease, preserve functioning lung as much as possible• Maintain clear airway devoid of mucopurulent secretions or blood +++ Indications + • Criteria for failure of medical therapy include:-Localized disease and completely resectable-Adequate pulmonary reserve-Irreversible process-Significant symptoms despite medical treatment +++ Complications + • Hemoptysis, lung, and brain abscess; empyema; respiratory failure; death• All complications decreased since anti-TB medications emerged +++ Prognosis + • 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% +++ Prevention + • Long-term antibiotic therapy may be needed for ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.