Chest Medicine













Bronchiectasis
  • Chronic inflammation of the bronchi and bronchioles leading to permanent dilatation and thinning of the airways
  • Common supra-added infections: H. influenza, S. pneumoniae, S. aureus, P. aeruginosa
  • Common associations: CF, Primary ciliary dyskinesia (including Kartagener’s syndrome), allergic bronchopulmonary aspergillosis (ABPA), ulcerative colitis, rheumatoid arthritis

Signs and Symptoms
  • Persistent productive cough
  • Haemoptysis
  • Digital clubbing, coarse inspiratory crepitations, wheeze

Investigation
  • Sputum microscopy and culture
  • Chest X-ray: cystic shadows, thickened bronchial walls
  • HRCT: signet ring signs
  • Spirometry: obstructive pattern
  • Bronchoscopy
  • Other tests: CF sweat test, aspergillus precipitins, serum immunoglobulins

    • CT chest: Black arrows show dilated bronchi; white arrows show dilated airway + pulmonary artery (hyperdense "diamond") (= signet ring sign. In healthy individuals, the size of the "diamond" (branch of pulmonary artery) should be roughly equal to that of the ring's diameter)

Management
  • Chest physical therapy + mucolytics
  • Antibiotics: according to sensitivity (e.g., P. aeruginosa → PO ciprofloxacin)
  • Bronchodilator: if co-existing asthma, COPD, CF or ABPA
  • Consider prednisolone + antifungal if ABPA
  • Consider surgery if severe haemoptysis

Reference: Oxford Handbook of Clinical Medicine (10th Ed)