Resident Report

1. Resident Report 7.26.2011

2. Bronchiectasis • Irreversibly dilated peripheral airways secondary to chronic inflammation from a variety of causes • Pathogenesis – inflammatory damage to bronchial wall leads to cycle of airway inflammation, bacterial colonization and infection that self-perpetuates • Reduction of clearance of respiratory secretions

3. Clinical Features • Chronic productive cough of purulent sputum • Sometimes dry cough can be presenting symptom • Frequently see hemoptysis – secondary to dilated bronchial vasculature which sometimes can bleed • Physical exam can show rhonchi, rales; often depends on how congested airway is with sputum

4. Causes • Congenital diseases – cystic fibrosis, primary ciliary dyskinesia, alpha-1-antitrypsin deficiency, • Infections – recurring pneumonias, non-tuberculous mycobacterial infections (especially MAC), childhood infections • Connective tissue disorders – Sjogren’s and RA especially • Inflammatory bowel disease • ABPA • COPD/asthma • Chronic Aspiration • Idopathic

5. Findings on Imaging • CXR – often will not be impressive • Chest CT is imaging of choice • Diameter of dilated airways larger than blood vessels (signet ring formation)

6. Treatment • Antibiotics – treat based on cultures obtained from sputum cultures • Trials with inconclusive evidence done on maintenance abx • Inhaled steroids • Macrolide antibiotics • Inhaled saline solution (mobilization of secretions) • Resection and Transplant

7. Take Home Points • Causes of hemoptysis • Workup of hemoptysis • Index of suspicion for TB in high risk patients • Pathogenesis, clinical features, treatment of bronchiectasis