Cystic Bronchiectasis

Having been treated for pulmonary tuberculosis (TB) 25 years earlier, a 60-year-old man (a nonsmoker) now complained of a chronic cough. The cough was occasionally accompanied by yellowish sputum but no hemoptysis. Examination revealed persistent coarse crackles in the right posterior hemithorax, and the x-ray study seen here established the diagnosis of cystic bronchiectasis.

Defined as chronic dilatation of the bronchi, bronchiectasis typically involves the medium-sized bronchi and may result from a host of congenital or acquired conditions. Most patients have a history of chronic cough and copious sputum; hemoptysis, wheezing, and dyspnea may develop as the disease progresses.

Drs Sonia Arunabh, Navin Verma, and Terence Brady of Flushing, NY, find that the most useful classification of bronchiectasis is of obstructive and nonobstructive types. Obstructive bronchiectasis, caused by tumor or any other blockage, is localized to the region distal to the obstruction, whereas the nonobstructive type is usually more widespread.

Nonobstructive bronchiectasis most frequently affects the basal segments of the lung, but when it is secondary to TB and cystic fibrosis, it may affect only the upper lobe. It is usually categorized as saccular, cystic, or varicose. In cystic bronchiectasis, dilatation is more common in the distal portions of the bronchi.

Many patients with bronchiectasis have had childhood respiratory infections: viral, bacterial (pertussis), or-as in this case-TB. Collapse and fibrosis of the surrounding lung weakens and exerts traction on the damaged bronchial walls, leading to permanent bronchial dilatation. A plain chest film may not always be diagnostic. If the condition is suspected, a high-resolution CT chest scan may help establish the diagnosis.

Initial treatment consists of hydration, postural drainage, bronchodilators, and-most important-appropriate antibiotic therapy. Patients may require suppressive antibiotics at regular intervals or over a prolonged period. Many do well on a tightly controlled program of medical treatment. For those who remain significantly symptomatic, surgical options should be considered.