21/05/2020
Bronchiectasis
Dr. (Ms.) K. Sounthararajan,
Senior Lecturer,
Unit of Siddha Medicine,
University of Jaffna.
Definition
Etiopathogenesis
Morphological features
Content Classifications
Clinical features
Complications
Abnormal and irreversible dilatation of the bronchi & bronchioles
Greater than 2mm in diameter
Developing secondary to inflammatory weakening of the
bronchial wall.
The most clinical manifestation of bronchiectasis is
Persistent cough with expectoration of copious amount of foul
smelling purulent sputum.
Definition Post infectious cases commonly develop in childhood and in early
adult life.
Two basic mechanism
Endobronchial obstruction (obstructive bronchiectasis)
Infection (infective bronchiectasis)
Endobronchial obstruction:-
By foreign body ,neoplastic growth/ enlarged lymph node
This is causes resorption of air distal to the obstruction
with consequent atelectasis and retention of secretions
Etiopathogenesis Infections:-
May be secondary to local obstruction
Impaired systemic defense mechanism promoting
bacterial growth / infection may be a primary event
Bronchiectasis developing in suppurative necrotizing
pneumonia
These 2 mechanisms are seen in a number of clinical settings as
under :-
1.hereditary and congenital factors
Congenital bronchiectasis caused by developmental defect of the bronchial
system
Cystic fibrosis-----> obstruction ---- > infection----- >bronchiectasis
Hereditary immune deficiency disease
Immotile cilia syndrome that includes Kartagener’s syndrome (bronchiectasis
,situs inversus and sinusitis)
Atopic bronchial asthma may rarely develop bronchiectasis
2.obstruction
Post obstructive bronchiectasis unlike the congenital-hereditary forms
It is localized variety
Usually confined to one part of the bronchial system
Obstruction caused by –foreign bodies, endobronchial tumors, compression
by enlarge hilar lymph nodes ,post inflammatory scarring (TB).
All of it favours the development of post obstructive bronchiectasis.
2.As secondary complication
Staphylococcal suppurative pneumonia & Tuberculosis may develop
bronchiectasis as a complication
The disease characteristically affects distal bronchi & bronchioles
beyond the segmental bronchi
G/A:-
Lungs may be involved diffusely / segmentally
Morphological Bilateral involvement of lower lobes occurs most frequently
Features Left lower lobe more involved than right lobe (more vertical air
passages)
Pleura is fibrotic and thickened with adhesion to the chest wall
Dilated airways depending upon their gross/ bronchographic
appearance
Cut surface of affected lobes shows characteristic Honey-
combed appearance
Bronchi are extensively dilated nearly to the pleura
Walls are thickened
The lumina are filled with mucus / muco pus
Intervening lung parenchyma is reduced and fibrotic
Bronchiectasis subclassified into the following types:-
1.Cylindrical :-
most common type
Characterised by tube like bronchial dilatation
2.Fusiform :-
Spindle shaped bronchial dilatation
3.Saccular :-
Rounded sac like bronchial distension
Classification
4.Varicose :-
Irregular bronchial enlargements
Microscopic/A :-
Bronchial epithelium may be normal / may show squamous
metaplasia
Bronchial wall shows infiltration by acute & chronic inflammatory
cells
Destruction of normal muscle replacement by fibrosis
Intervening lung parenchyma shows fibrosis
Pleura in the affected area is adherent & shows bands of fibrous
tissue between the bronchus & pleura
Chronic cough with foul smelling sputum
Haemoptysis
Clinical Recurrent pneumonia
features Sinusitis is a common accompaniment of diffuse
bronchiectasis
In late stage may develop clubbing of fingers
Metastatic abscess (often to the brain)
Amyloidosis
complications Cor pulmonale
Clubbing of the fingers
Thank you
