Bronciectasis

Bronciectasis

1. Bronciectasis
•Bronchiectasis is permanent dilation of bronchi and
bronchioles due to destruction of muscle and elastic
tissue,
•Resulting from or associated with chronic
necrotizing infections.
•It is not a primary disease but rather is secondary
to persisting infection or obstruction caused
•Characteristic symptoms; cough and expectoration
of copious amounts of purulent sputum.

2. Predisposing factors
•Bronchial obstruction.
–Foreign bodies, impaction(The condition of being pressed closely together
and firmly fixed) of mucus; atopic asthma and chronic bronchitis.
•Congenital or hereditary conditions.
–Cystic fibrosis: abnormally viscid mucus.
–Immunodeficiency states; increased susceptibility to repeated infections;
–Kartagener syndrome, an autosomal recessive disorder; Bronchiectasis ,
Sinusitis, Situs Inversus and Sterility in males.
•Necrotizing, or suppurative, pneumonia, by Staphylococcus aureus or
Klebsiella
•
•Others complicated measles, whooping cough, and influenza, post-
tubercular

3. Bronciectasis
Mechanism Disease

4. Pathogenesis
•Two processes are crucial and intertwined in the
pathogenesis of bronchiectasis:
–obstruction and chronic persistent infection.
•Either of these two processes may come first.
–Normal clearance mechanisms are hampered by
obstruction, so secondary infections;
–Conversely, chronic infection in time causes damage
to bronchial walls, leading to weakening and dilation.

5. Pathogenesis

6. Morphology
•Usually affects the lower lobes bilaterally, particularly
those air passages that are vertical.
•Tumors or aspiration of foreign bodies; involvement may
be localized to a single segment of lungs.
•
•Most severe involvement is found in the more distal
bronchi and bronchioles.
•Airways may be dilated to as much as four times their
usual diameter and on gross examination of the lung can
be followed almost to the pleural surfaces

7. Morphology: Microscopic features
•Findings vary with the activity and chronicity of the disease

•In the full-blown active case;
–Intense acute and chronic inflammatory exudate within the walls of
bronchi and bronchioles
–Desquamation(Loss of bits of outer skin by peeling, shedding or coming
off in scales) of lining epithelium cause extensive areas of ulceration.
•When healing; lining epithelium may regenerate but as much injury has
occurred; abnormal dilation and scarring
–Peribronchiolar fibrosis develop in more chronic cases.
• In some instances, the necrosis destroys the bronchial or bronchiolar
walls and forms a lung abscess

8. Normal
Lung tissue
Bronciectasis

9. Bronchiectasis. Cross-section of lung demonstrating dilated
bronchi extending almost to the pleura

10. Clinical manifestations
•Severe, persistent cough with expectoration of
mucopurulent sputum.
–Sputum; flecks of blood; frank hemoptysis
•Symptoms are often episodic; precipitated by upper
URTI
•Clubbing of the fingers may develop.
•In severe, widespread:
–Significant obstructive ventilatory defects, with hypoxemia,
hypercapnia, pulmonary hypertension, and (rarely) cor
pulmonale.
•Metastatic brain abscesses and reactive amyloidosis