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Wednesday, February 2, 2011

Bronchiectasis.


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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