Bronchiectasis is a severe, chronic infection of the lung causing pronounced
permanent abnormal dilatation of bronchi and
- Chronic, necrotizing infection of bronchi in a segment or multiple segments of
- Infection damages and weakens walls of bronchi so that these
structures become markedly dilated and filled with
mucous and pus.
- The major factors which contribute to the development of bronchiectasis are
loss of muco-ciliary clearance system and infection.
- The loss of muco-coliary escalator system can follow either obstruction
(foreign body) or due to defect in dynein arm of cilia (Kartagener's
syndrome) or due to abnormal mucus (Cystic fibrosis).
- Defect in the clearance mechanism is followed by accumulation of secretions,
bacterial overgrowth, infection and atelectasis.
- The chronic infection damages the integrity of the bronchial wall causing
- Temporary (6 Weeks) tubular bronchial dilatation occur in all pneumonias.
- Saccular follows destructive inflammation of
the bronchial wall.
- The muco-ciliary escalator system is destroyed in bronchiectatic segments
perpetuating accumulation of secretions and infection.
- The bronchiectatic segments are also insensitive thus do not
provoke cough until the pus spills over to normal bronchi.
- Airway obstruction follows diffuse
- If there is significant recurrent pneumonias and peribronchial fibrosis
a restrictive defect can be seen.
Localized vs. Diffuse Bronchiectasis
- Localized bronchiectasis is encountered under the following
Following necrotizing pneumonia
Tuberculosis (dry bronchiectasis)
Allergic bronchopulmonary aspergillosis
- Diffuse bronchiectasis is encountered in:
Immobile Cilia Syndrome (Kartagener's Trial)
- Clinically characterized by postural cough and expectoration of large
quantities of foul smelling sputum with three
characteristic layers. Foul smell is due to anaerobic infection. The three
layers are purulent sediment, clear middle liquid and top foamy layer.
Bronchiectatic segments are insensitive and do not provoke cough. When the patient bends
down the gravity moves the pus to proximal normal bronchi evoking a cough response, thus
explaining the postural cough.
- Clubbing, coarse persistent leathery rales are
- Chest x-ray is often normal, but can show thickened bronchial
walls, multiple cystic spaces with air fluid levels.
- Characteristic dilated bronchi can be demonstrated with high resolution CT. Bronchogram is no longer necessary.
- A combined obstructive and restrictive defect can be seen in
- Localized bronchiectasis can be cured with resection, if
- Cyclical antibiotics and postural drainage are
the mainstay of therapeutic measures for diffuse bronchiectasis.
- Lung transplant is an option for far advanced cases.