Definition: It is a condition of chronic or permanent dilatation of the bronchioles.
Aetiology (causes): I.
Mechanical - (a) Inhalation of a foreign body.
(b) Pressure of an aneurysm.
(c) Bronchopulmonary neoplasm.
(d) Calcified tuberculous glands.
(e) Pulmonary fibrosis resulting from - (i) Bronchopneumonia, (ii) Syphilis, (iii) Tuberculosis (iv) penetrating chest wounds II.
Infective - (a) Chronic Suppurative bronchitis.
(b) Lung abscess.
(c) Measles.
(d) Whooping cough.
III.
Congenital - (a) Atelectasis.
(b) Kartagener's syndrome.
(c) Fibrocystic disease of pancreas.
Pathology: The bronchial dilatations may be cylindrical or tubular, sacular or globular, fusiform or pyriform, moniliform or bead like.
The bronchiectatic cavities mostly formed in lower lobes.
Lining membrane is formed by granulation tissue or ciliated epithelium.
Inflammatory changes are found in deeper layers of bronchial walls.
Surrounding lung tissues may be fibrosed.
Clinical Features: Symptoms - (a) Cough with expectoration, usually worse in morning, with foul and putrid sputum.
(b) Hemoptysis, ranging in amount from blood stained sputum to massive hemorrhage.
(c) Fever, when acute inflammation is superimposed.
(d) Chest pain, night sweating, loss of weight etc.
may be present.
Signs: (1) General-Evidence of toxemia shown by wasting, stunted growth, cyanosis, clubbing of fingers and toes, dyspnoea, sputum-large.
Foul.
(2) Inspection-Chest movements diminished on the affected side.
(3) Palpation-Vocal fremitus diminished.
(4) Percussion-Impaired resonance.
(5) Auscultation- Bronchial or cavernous breathing, with bronchophony.
Cardiac apex displaced to the side of lesion, coarse crepitations over the affected area.
Investigations: (a) Blood shows leucocytosis with increased polymorphs.
(b) Sputum-in a conical flask it shows 3 layers frothy above, turbid in centre deposit below.
Culture usually shows H.
influenzae.
(c) X-ray of chest shows areas of fibrosis or haziness, with increased bronchial markings.
(d) Lipidobronchography usually confirms dilatation.
(e) Bronchoscopy-seldom helpful.
Prognosis: In case of early diagnosis and proper treatment prognosis is good.
Differential Diagnosis: (a) Chronic Suppurative bronchitis.
(b) Interlobar empyema.
(c) Lung abscess.
(d) Congenital cystic diseased of the lungs.
(e) Bronchial carcinoma.
(f) Pulmonary tuberculosis Complications: (a) Bronchopneumonia.
(b) Lung abscess or gangrene.
(c) Dry pleurisy.
(d) Empyema.
(e) Pyopneumothorax.
(f) Pericarditis.
(g) Septicemia and pyemia.
Treatment: (1) Postural drainage-this depends on the site of the lesion.
(2) Inspiratory breathing exercises.
(3) Bed rest, good nutritious food.
(4) Chronic sepsis in the nose, mouth and pharynx should be treated.
(5) Anemia should be corrected.
(6) Surgical treatment - indicated in localized lesions in young patients with compatible general condition.
Aetiology (causes): I.
Mechanical - (a) Inhalation of a foreign body.
(b) Pressure of an aneurysm.
(c) Bronchopulmonary neoplasm.
(d) Calcified tuberculous glands.
(e) Pulmonary fibrosis resulting from - (i) Bronchopneumonia, (ii) Syphilis, (iii) Tuberculosis (iv) penetrating chest wounds II.
Infective - (a) Chronic Suppurative bronchitis.
(b) Lung abscess.
(c) Measles.
(d) Whooping cough.
III.
Congenital - (a) Atelectasis.
(b) Kartagener's syndrome.
(c) Fibrocystic disease of pancreas.
Pathology: The bronchial dilatations may be cylindrical or tubular, sacular or globular, fusiform or pyriform, moniliform or bead like.
The bronchiectatic cavities mostly formed in lower lobes.
Lining membrane is formed by granulation tissue or ciliated epithelium.
Inflammatory changes are found in deeper layers of bronchial walls.
Surrounding lung tissues may be fibrosed.
Clinical Features: Symptoms - (a) Cough with expectoration, usually worse in morning, with foul and putrid sputum.
(b) Hemoptysis, ranging in amount from blood stained sputum to massive hemorrhage.
(c) Fever, when acute inflammation is superimposed.
(d) Chest pain, night sweating, loss of weight etc.
may be present.
Signs: (1) General-Evidence of toxemia shown by wasting, stunted growth, cyanosis, clubbing of fingers and toes, dyspnoea, sputum-large.
Foul.
(2) Inspection-Chest movements diminished on the affected side.
(3) Palpation-Vocal fremitus diminished.
(4) Percussion-Impaired resonance.
(5) Auscultation- Bronchial or cavernous breathing, with bronchophony.
Cardiac apex displaced to the side of lesion, coarse crepitations over the affected area.
Investigations: (a) Blood shows leucocytosis with increased polymorphs.
(b) Sputum-in a conical flask it shows 3 layers frothy above, turbid in centre deposit below.
Culture usually shows H.
influenzae.
(c) X-ray of chest shows areas of fibrosis or haziness, with increased bronchial markings.
(d) Lipidobronchography usually confirms dilatation.
(e) Bronchoscopy-seldom helpful.
Prognosis: In case of early diagnosis and proper treatment prognosis is good.
Differential Diagnosis: (a) Chronic Suppurative bronchitis.
(b) Interlobar empyema.
(c) Lung abscess.
(d) Congenital cystic diseased of the lungs.
(e) Bronchial carcinoma.
(f) Pulmonary tuberculosis Complications: (a) Bronchopneumonia.
(b) Lung abscess or gangrene.
(c) Dry pleurisy.
(d) Empyema.
(e) Pyopneumothorax.
(f) Pericarditis.
(g) Septicemia and pyemia.
Treatment: (1) Postural drainage-this depends on the site of the lesion.
(2) Inspiratory breathing exercises.
(3) Bed rest, good nutritious food.
(4) Chronic sepsis in the nose, mouth and pharynx should be treated.
(5) Anemia should be corrected.
(6) Surgical treatment - indicated in localized lesions in young patients with compatible general condition.