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
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
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
Chronic Cough with copious mucus production
frank hemoptysis can occur
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