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Presentant : Reni Indrastuti
Konsultant : dr. H. Edy Moeljono, Sp.Rad (K), RA
Text Book Reading
David Sutton Radiology and Imaging
7thth
ed vol.1 Section 1, page 163-165
“Disease of The Airway”
BronchiectasisBronchiectasis

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Introduction
Definition
• Most common in children,
• Increasing breathlessness
•Chronic cough with excess
sputum
• Hemoptysis
• Recurent infection with
exacerbasi akut
is the irreversible dilatation of one or
more bronchi,
and is usually the result of severe,
recurrent or chronic infection
A–Z of Chest Radiology
David Sutton
Bronchiectasis usually involves the
peripheral bronchi more severely
than the central bronchi
Clinical
presentation

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Anatomy of the bronchi
• The trachea bifurcates, giving rise to the left and right main stem
bronchi.
• the right main stem bronchus is more vertical, wider by about 2
mm, and approximately half the length of the left main stem
bronchus
Normal dimension of main bronchi from
chest radiograph
Paul and Juhl's Essentials of Radiologic Imaging

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AnatomyAnatomy
chestradiology.net Clinical anatomy 11 ed 2006

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Cause of BronchiectasisCause of Bronchiectasis
Broncholith
Retraction of parenchyma (fibrosis)
Obstruction by foreign body
Neoplastic obstruction
Cartilage deficiency (Williams-Campbell
syndrome)
Cilia syndrome (Kartagener syndrome)
Host defenses down (agammaglobulinemia)
Infection
Emphysema
Cystic fibrosis
Chronic granulomatous disease
Tuberculosis
Allergic bronchopulmonary aspergillosis
Swyer-James syndrome
Inhalation injury (ammonia, gastric acid)
Sarcoidosis (uncommon)
Chest Radiology: The Essentials, 2nd Edition, Collins, Jannette; Stern, Eric J
Mechanisme :
1.Bronchial
Obstruction :
carcinoma,
broncholithiasis,
extensive compression,
etc.
2.Bronchial wall injury,
ex ; cystic fibrosis,
Childhood viral and
bacterial infection, etc.
3.Parenchymal fibrosis
(Traction ) : TB,
sarcoidosis, idiopathic
pulmonary fibrosis
Grainger & Allison's Diagnostic Radiology, 5th ed

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Category and typesCategory and types
mildest
Most severe
A–Z of Chest Radiology

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DiagnosisDiagnosis
http://emedicine.medscape.com/article/296961-overview#aw2aab6b2b1aa

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Radiologic FeaturesRadiologic Features
Type Feature
CXR cylindric Linear lucencies and parallel markings radiating from
the hila (tram tracking), smooth unformly dilated
varicose Dilated bronchi, non-uniform dilatation
cystic Clustered cysts, non-uniform dilatation,has ulceration
with bronchial neovascularisation, sometimes with air
fluid level
CT cylindric parallel tram track lines or may have a signet-ring
appearance composed of a dilated bronchus cut in a
horizontal section with an adjacent pulmonary artery
representing the stone
Varicose irregular or beaded bronchi, with alternating areas of
dilatation and constriction
cystic large cystic spaces and a honeycomb appearance,
http://emedicine.medscape.com/article/296961-overview#aw2aab6b2b1aa

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Radiologic Figure CXR vs CTRadiologic Figure CXR vs CT
Gambarcxr
1. Sylindric
Cylindric
1. cystic
Gmbarct
http://emedicine.medscape.com/article/296961-overview#aw2aab6b2b1aa
Sutton
WHO Manual
Chest Radiology: The Essentials, 2nd Edition, Collins, Jannette; Stern, Eric J
CysticVaricose

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CXR of Cystic BronchiectasisCXR of Cystic Bronchiectasis
The WHO manual of diagnostic imagingRSUD BANTUL

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Differential DiagnosisDifferential Diagnosis
No Signs Modality DD
1. Honey comb
appearance
CXR and CT Bronchiectasis,
advanced pumonary
fibrosis
2. Cyst CT Cystic bronchiectasis,
bullous emphysema

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ResumeResume
• Introduction
• Anatomy
• Cause and Mechanisme Bronchiectasis
• Category and Type
• Diagnosis
• Radiologic feature
• Radiologic Figure
• Cystic bronchiectasis
• Differensial Diagnosis

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QuizQuiz
31-year-old man is admitted with
increasing cough, fever, and sputum
production. He gives a history of
repeated infections and “pneumonias”
since childhood. Routine labs are
normal except for a
polymorphonuclear leukocytosis.
Chest radiograph is shown beside
1. Please describe the picture!
2. What is the most likely diagnosis?

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Terimakasih dan Mohon AsupanTerimakasih dan Mohon Asupan

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Ct cylindric
Cylindrical bronchiectasis with signet-ring
appearance. Note that the luminal airway diameter is
greater than the diameter of the adjacent vessel.
http://emedicine.medscape.com/article/296961-overview#aw2aab6b2b1aa

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Cxr cylindric and cystic
Cystic and cylindrical bronchiectasis of the
right lower lobe on a posterior-anterior
chest radiograph.
http://emedicine.medscape.com/article/296961-overview#aw2aab6b2b1aa

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Ct varicose
Varicose bronchiectasis with alternating
areas of bronchial dilatation and
constriction.
http://emedicine.medscape.com/article/296961-overview#aw2aab6b2b1aa

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Ct cystic and varicose
This CT scan depicts areas of both cystic
bronchiectasis and varicose
bronchiectasis.
http://emedicine.medscape.com/article/296961-overview#aw2aab6b2b1aa

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Ct cystic
sutton

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cystic
FIG. 26-8. Extensive cystic disease or cystic bronchiectasis. A:
Extensive bilateral inflammatory disease in which some
rounded radiolucencies can be outlined. B:
Right bronchogram shows extensive bronchiectasis, which is cystic
and cylindrical

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CYSTIC
Chest Radiology: The Essentials, 2nd Edition, Collins, Jannette; Stern, Eric J

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Cylindric
Frontal CXR of a patient with cylindrical bronchiectasis, on the magnified
image are ring shadows (white arrows) and
tram lines (black arrows), representing dilated bronchi end on and lengthways
respectively
The WHO manual of diagnostic imaging

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varicose
Left image is a frontal CXR of an asthmatic patient with
ABPA. Note the patchy consolidation, bronchial wall
thickening and bronchial dilatation (white arrows). The right
image is an HRCT of the same patient demonstrating
the bronchiectasis. The distribution is typically central in the
mid and upper zones
The WHO manual of diagnostic imaging

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cystic
Frontal and lateral CXR of a patient with cyctic
bronchiectasis secondary to a childhood infection and
confined
to the right middle lobe. Note the “cysts” with thin walls
(black arrows). The “cysts are either focal dilatation
of the bronchi or saccular out-pouchings from the bronchi
The WHO manual of diagnostic imaging

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Mechanisme bronchiectasis
• three mechanisms by which the dilatation can develop:
• bronchial obstruction, bronchial wall damage, and parenchymal fibrosis
( Table 16.1 ).
• In the first two mechanisms, the common factor is the combination of mucus
plugging and bacterial colonization. Cytokines and enzymes released by
inflammatory cells plus toxins from the bacteria result in a vicious cycle of
increasing airway wall damage, mucous retention and bacterial proliferation.
• In parenchymal fibrosis, the dilatation of bronchi is caused by maturation
and retraction of fibrous tissue located in the parenchyma adjacent to an
airway (traction bronchiectasis
Grainger & Allison's Diagnostic Radiology, 5th ed

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Pathophysiology
• Bronchiectasis is an abnormal dilation of the proximal and medium-
sized bronchi (>2 mm in diameter) caused by weakening or
destruction of the muscular and elastic components of the bronchial
walls. Affected areas may show a variety of changes, including
transmural inflammation, edema, scarring, and ulceration, among
other findings. Distal lung parenchyma may also be damaged
secondary to persistent microbial infection and frequent
postobstructive pneumonia. Bronchiectasis can be congenital but is
most often acquired
http://emedicine.medscape.com/article/296961-overview#aw2aab6b2b1aa

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