permanent dilation of bronchi and bronchioles caused by destruction of the muscle and elastic supporting tissue, resulting from or associated with chronic necrotizing infections
c/f: cough and expectoration of copious amounts of purulent sputum
Causes of bronchiectasis:
Bronchial obstruction, eg, tumors, foreign bodies, and impaction of mucus
cystic fibrosis: viscid mucus impairing the mucociliary elevator
immunoglobulin deficiencies: lack of opsonisation predisposes to different capsulated bacteria
Kartagener syndrome: immotile cilia syndrome
Necrotizing, or suppurative, pneumonia, esp with virulent organisms like Staphylococcus aureus or Klebsiella
pneumonia that complicated measles, whooping cough, and influenza are important causes in children
Post-tubercular bronchiectasis
obstruction and chronic persistent infection form a vicious cycle - Either of these two processes may come first
Morphology of a bronchiectatic lung:
lower lobes are usually involved, bilaterally
Bronchiectasis due to foreign bodies may be sharply localized to a single segment of the lungs
The bronchi are dilated upto four times and can be followed almost to the pleural surfaces
M/E shows intense acute and chronic inflammatory exudate within the walls of the bronchi and bronchioles and the desquamation of lining epithelium
peribronchiolar fibrosis
May frequently form a lung abscess.
Culture grows mixed organisms like staphylococci, streptococci, pneumococci, enteric organisms, anaerobic and microaerophilic bacteria, and Haemophilus influenzae( esp toddlers)and Pseudomonas aeruginosa
Clinical features:
Chronic Cough with copious mucus production
frank hemoptysis can occur
Clubbing
obstructive ventilatory defects develop, with hypoxemia, hypercapnia, pulmonary hypertension, and (rarely) cor pulmonale.
Lung abscesses- pt becomes toxic, with foul smelling copious sputum production, especially in a particular position of the patient.
Metastatic brain abscesses
Reactive amyloidosis.
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