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🌟 Bronchiectasis

 🎯 Pathology​

  • a chronic lung condition characterised by permanent dilatation of the airways and impaired mucociliary clearance leading to recurrent infections

 💡 Causes​

  • idiopathic

  • infection-related

    • bacterial —> tuberculosis

    • viral —> measles, respiratory syncytial virus (RSV)

    • fungal —> allergic bronchopulmonary aspergillosis (ABPA)

  • genetic

    • cystic fibrosis, primary ciliary dyskinesia (Kartagener syndrome), alpha 1-antitrypsin deficiency

🩺 Clinical features​

  • signs

    • chronic productive cough

    • purulent sputum

    • haemoptysis

    • coarse crackles and wheeze on auscultation

  • symptoms

    • dyspnoea

    • pleuritic chest pain due to chronic cough

  • be aware of the features of the associated conditions (e.g. cystic fibrosis, Kartagener syndrome)

🕵️‍♂️ Investigations

  • bloods

    • exclude ABPA

  • sputum culture

    • exclude TB

  • sweat test

    • exclude cystic fibrosis (> 60 mEq/l)

  • imaging

    • initial —> chest x-ray

    • best —> high-resolution CT scan

      • tram-track sign and signet rings

💆‍♂️ Management

  • treat the underlying cause (e.g. cystic fibrosis)

  • conservative

    • postural drainage

    • deep breathing exercises

    • smoking cessation

    • vaccinations

  • medical management

    • antibiotics

    • bronchodilators

  • surgical management

    • resection or transplantation

🧲 High-yield tips

  • most common organism isolated from patients with bronchiectasis

    • haemophilius influenzae

  • kartagener syndrome tetrad

    • bronchiectasis + chronic sinusitis + situs inversus + subfertility

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