Bronchiectasis is permanent irreversible dilatation of the airways and occurs in a variety of pathologic processes. Recurrent infection and inflammation and the resulting chemical and cellular cascade lead to permanent architectural changes in the airways. Bronchiectasis can confer substantial potential morbidity, usually secondary to recurrent infection. In severe cases of bronchiectasis, massive hemoptysis can lead to death. Thin-section computed tomography is the most sensitive imaging modality for the detection of bronchiectasis; findings include bronchial diameter exceeding that of the adjacent pulmonary artery and lack of normal tapering of terminal bronchioles as they course toward the lung periphery. 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. The authors will also present an approach emphasizing the distribution (apical versus basal and central versus peripheral) and concomitant findings, such as nodules, cavities, and/or lymphadenopathy, that can assist in narrowing the differential diagnosis. Although an adequate understanding of these underlying causes in conjunction with their specific imaging appearances will allow radiologists to more confidently determine the process causing this common radiologic finding, clinical history and patient demographic characteristics play an integral role in determining a pertinent and concise differential diagnosis.
Bronchiectasis represents irreversible bronchial dilatation. It can be focal or diffuse, and usually results from chronic infection, proximal airway obstruction, or a congenital bronchial abnormality. Traction bronchiectasis refers to irregular bronchial dilatation in the setting of surrounding pulmonary fibrosis. Patients with cystic fibrosis have a progressively worsening clinical course, with recurrent pneumonias and chronic airway colonization. Even with lung transplantation and modern antibiotic therapies, average life expectancy of cystic fibrosis patients remains limited to young adulthood. Non-cystic fibrosis related bronchiectasis can cause chronic cough and recurrent lung infection. Pulmonary function testing often reveals evidence of obstruction. Treatment of patients with mild to moderate bronchiectasis involves supportive care with bronchodilators, antibiotics, and other medical therapy. Surgical resection is uncommon, and usually reserved for cases of significant bronchiectasis limited to a single region of the lungs (such as a particular lobe or segment).
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