1. Resident Report 7.26.2011

2. Bronchiectasis Irreversibly dilated peripheral airways secondary to chronic inflammation from a variety of causes Pathogenesis – inflammatory damage to bronchial wall leads to cycle of airway inflammation, bacterial colonization and infection that self-perpetuates Reduction of clearance of respiratory secretions

3. Clinical Features Chronic productive cough of purulent sputum Sometimes dry cough can be presenting symptom Frequently see hemoptysis – secondary to dilated bronchial vasculature which sometimes can bleed Physical exam can show rhonchi, rales; often depends on how congested airway is with sputum

4. Causes Congenital diseases – cystic fibrosis, primary ciliary dyskinesia, alpha-1-antitrypsin deficiency, Infections – recurring pneumonias, non-tuberculous mycobacterial infections (especially MAC), childhood infections Connective tissue disorders – Sjogren’s and RA especially Inflammatory bowel disease ABPA COPD/asthma Chronic Aspiration Idopathic

5. Findings on Imaging CXR – often will not be impressive Chest CT is imaging of choice Diameter of dilated airways larger than blood vessels (signet ring formation)

6. Treatment Antibiotics – treat based on cultures obtained from sputum cultures Trials with inconclusive evidence done on maintenance abx Inhaled steroids Macrolide antibiotics Inhaled saline solution (mobilization of secretions) Resection and Transplant

7. Take Home Points Causes of hemoptysis Workup of hemoptysis Index of suspicion for TB in high risk patients Pathogenesis, clinical features, treatment of bronchiectasis