flashpath - lung - bronchiectasis
TRANSCRIPT
FLASHPATHH a z e m A l i
BRONCHIECTASIS
H a z e m A l i
CLINICAL
Bronchiectasis is one of the “obstructive lung diseases” that include:• Chronic bronchitis
• Emphysema
• Small-airway disease “bronchiolitis”
• Asthma
CLINICALObstructive airway
diseaseRestrictive airway
diseaseGeneral features Increase in resistance to
airflow due to obstruction at any level
Reduced expansion of lung parenchyma
Total lung capacity (TLC)
Increased Reduced
Forced Expiratory Volume in one second (FEV1)
Reduced Normal
CLINICAL• Bronchiectasis is permanent dilation and destruction of the
airways– 2ry to recurrent infections and bronchial obstruction– Mainly affect bronchi and bronchioles proximal to the terminal
bronchioles
• Usually present with:– Chronic, productive cough
• Copious amount of foul smelling, purulent sputum– Dyspnea– Fever– Others: of the original cause / associated complications
CLINICAL• High-resolution CT is the procedure of choice for noninvasive
diagnosis– Bronchiectasis is radiologically classified into:
• Cylindrical• Saccular• Cystic
• Effective antibiotic therapy has led to a marked decrease in the incidence of bronchiectasis and its complications:
– Bronchopleural fistula with empyema– Brain abscess– 2ry (systemic) Amyloidosis
CLINICALCauses of
bronchiectasis
Congenital Necrotizing Pneumonia
Bronchial Obstructio
nInflammatory Disorders Idiopathic
• Cystic fibrosis• Intralobar
sequestration• Primary ciliary
dyskinesia• Kartagener syndromes
• Bacteria• Staph,
Strept• Pseudomona
s• TB
• Viruses• Pertussis• Measles
• Fungi
• True obstruction:• Tumor• Foreign bodies• Mucus
impaction• Functional
obstruction:• COPD
• RA• SLE• IBD• Transplant
rejection
CLINICAL• Cystic fibrosis is commonly associated with Bronchiectasis, due to:
– Obstruction (mucus plugs)– Infection (decreased ciliary clearance of bacteria)
• Defective ciliary function (dyskinesia) is also associated with Bronchiectasis, e.g. Kartegener syndrome:
– Autosomal recessive– Absent or irregular dynein arms (motor part) of cilia– Defective bacterial clearance (bronchiectasis, sinusitis)– Defective cell motility during embryogenesis (situs inversus)– Defective sperm movement (male infertility)
CLINICAL
• Aspergilloma (fungal ball) can occur within pulmonary cavities (e.g. prior TB, Bronchiectasis, old Infarcts, or lung Abscesses).
• Allergic bronchopulmonary aspergillosis (occurs with asthma and cystic fibrosis) may lead to proximal bronchiectasis and fibrotic lung disease
PATHOGENESISAccumulation of Secretions
Secondary Infection
Inflammation,Necrosis,Fibrosis
Permanent Dilatation of
bronchi
More Accumulation of Secretions
Bronchial Obstruction
GROSS• Mainly noticed at the lower lobes
• Bilateral in 50% of cases
• Bronchi are markedly dilated– Diameter of the bronchus exceeds the diameterof the accompanying bronchial artery– Can form cystic spaces
• Bronchi are filled with yellowish-greenish secretions
GROSS• Sometimes the dilated bronchi can extend out to the
pleural surface– Normally, the bronchioles cannot be followed by eye beyond a
point 2 to 3 cm from the pleural surfaces
Also other features of Cause/Complications:• Pneumonia• Lung abscesses• Empyema• Aspergillosis• Tumor• Foreign body
MICROSCOPYAirways:• Bronchial Architecture:
– Dilated (may be cystic)– Mucopurulent exudate
• Mucosa:– Erosion/Ulceration– Squamous metaplasia
• Wall:– Chronic Inflammation (+/- prominent lymphoid follicles)– Destruction of cartilage / muscle / submucosal glands– Fibrosis
Also other features of Cause/Complications:• Pneumonia• Lung abscesses• Empyema• Aspergillosis• Tumor• Foreign body
CYTOLOGY
In long-standing bronchiectasis you get atypical squamous metaplasia and isolated bizarre squamous cells
– You need numerous bizarre cells to diagnose SCC with confidence
DIFFERENTIAL DIAGNOSIS
Chronic bronchitis
Bronchiectasis Asthma
Small-airway disease
“bronchiolitis”
Emphysema
Site L a r g e a i r w a y s ( B r o n c h i ) Bronchioles AlveoliMajor
pathology
• Mucous gland hyperplasia
• Excess mucus
• Inflammation
• Airway dilation & scarring
• Thickened basement membrane
• Smooth muscle hyperplasia
• Excess mucus
• Inflammation(eosinophils)
• Inflammatory scarring & obliteration
• Airspace enlargement
• Wall destruction
• No fibrosis
Other obstructive lung diseases:
DIFFERENTIAL DIAGNOSISOther causes of chronic cough• Lung carcinoma• Bronchiectasis• Cystic fibrosis• Congestive heart failure• Tuberculosis
DIFFERENTIAL DIAGNOSISO t h e r c o n g e n i t a l / c y s t i c l u n g d i s e a s e s :• Congenital:
– Bronchogenic cysts– Congenital pulmonary cysts– Congenital pulmonary airway malformation– Congenital lobar emphysema– Pulmonary sequestration
• Acquired:– Healed abscess– Honeycombing– Emphysema
DIFFERENTIAL DIAGNOSISMiddle lobe syndrome:• Chronic or recurrent atelectasis (radiographic opacification) of the right
middle lobe, lingula, or both• Mainly due to bronchial obstruction:
– Enlarged lymph nodes– Tumor
• Combinations of the following features:– Atelectasis– Bronchiectasis– Chronic inflammation (+/- Lymphoid hyperplasia)– Organizing pneumonia– Abscesses– Granulomatous inflammation
WWW.
DO NOT FORGET TO SEARCH FOR MORE PICS AND VIRTUAL SLIDES
THANK YOUH a z e m A l i