Case 10
History
The patient is a 22-year-old male with productive cough of long duration.
PA chest radiograph demonstrates multiple thin-walled
cysts distributed centrally, many with air-fluid levels.
Lateral chest radiograph demonstrates multiple thin-
walled cysts distributed centrally, many with air-fluid
levels.
High resolution CT confirming the multiple cystic areas
consisting of centrally dilated bronchi, some of which
contain inspisated mucus, in the lower lobes.
Diagnosis
Cystic Bronchiectasis.
Findings
Bronchiectasis is defined as an irreversible abnormal dilatation of the bronchial tree. In industrialized societies, the most important cause is Cystic Fibrosis. Post infectious Bronchiectasis is still a significant etiology in non-industrial societies. Conditions characterized by impaired mucociliary clearance such as CF and Dyskinetic Cilia Syndrome are associated with bronchiectasis. Chronic inflammation leads to bronchial wall damage and dilatation secondary to bronchial obstruction. Diseases associated with bronchial wall infection such as Chronic Granulomatous Disease of Childhood, Agammaglobulinemia, Measles, and Pertussis Pneumonia also cause Bronchiectasis. Tuberculosis, Sarcoidosis, Chronic Aspiration and Chronic Bronchitis are also associated with Bronchiectasis.
There are three pathologic groups of Bronchiectasis:
- Group I: Cylindrical Bronchiectasis
- Group II: Varicose Bronchiectasis
- Group III: Saccular or Cystic Bronchiectasis
Radiographic findings include generalized increased pulmonary markings, peribronchial fibrosis, atelectasis, and pleural thickening. In more advanced disease, especially in groups II and III, cystic spaces (up to 2 cm in diameter) may be identified. They frequently have fluid levels which may be purulent. The cysts may enlarge on inspiration and collapse on expiration, since the cysts communicate with the airway. The cysts are usually multiple, thin walled, and have a predilection for the lower lobes. Clinical manifestations include productive cough or hemoptysis. Prognosis is related to antibiotic therapy.
