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Bronchiectasis: Differential Diagnosis

by Carlo Raj, MD
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    00:00 Chronic bronchitis.

    00:02 If bronchiectasis will have more sputum production, more likely to then have infection such as Pseudomonas As we go to the differentials, and when you have bronchiectasis, you will be producing a lot more sputum hence that cup becomes really important to distinguish between the two and its infection that you're going to find with bronchiectasis, maybe such as Pseudomonas and that's something that you should be thinking about in a patient that has a chromosome 7 CFTR type of issue You're thinking about your chloride channel, Pseudomonas oftentimes is a bacteria that's affecting such patients causing pneumonia even Now ABPA stands for Aspergillus Bronchopulmonary Type of Issues, Asthma And them MAI which stands for Mycobacterium avium intracellulare Now these are infections that also might be present, if it's MAI, then you might be thinking about a patient that's immunocompromised and Allergic Bronchopulmonary Aspergillosis, well this is maybe taking advantage of a pre-cavitation from TB perhaps treat separately and the differential diagnosis less of an issue it's more important to know the cause, the cause, the cause So once you find such an issue taking place in productive cough, and you know that this infection's setting in, please find the cause don't fight over the diagnosis, and for Pete's sakes get rid of the organism through proper antibiotics, either antipseudomonal, or whatever that the infection might be, either antifungal, so on and so forth.

    01:33 Now, with bronchiectasis and further differentials, cystic fibrosis, well here you're thinking about a young child but what's cystic fibrosis? Well there might be plugging up of all of your ducts, it might not only with the patient then appear with having issues in the lung and may result in bronchiectasis but then it may also have issues in the pancreas.

    01:54 In fact, one of the common causes of acute pancreatitis in a child will be cystic fibrosis, usually Caucasian.

    02:02 Bronchopulmonary infections such as staph and tuberculosis sometimes will occur in COPD and immunodeficient patients oftentimes prone to infections as well.

    02:14 Some risk factors that all come in here in bronchiectasis Remember, secondary, secondary, secondary, as far as differentials are concerned your primary importance at that point is to make sure that you are taking care of the underlying cause versus battling over the diagnosis.

    02:29 And then secondary is, what exactly is causing the increased mucus production therefore predisposing your patient to infection then setting in Hereditary diseases, continue risk factors, for example: say that your patient doesn't have proper cilia or your primary ciliary dyskinesia something like Kartagener Syndrome, we have dextrocardia embryologically speaking can't properly get rid of substances, atypical mycobacterium infections and once again, allergic bronchopulmonary aspergillosis right middle lobe syndrome, yellow nail syndrome and pay attention here, this is inflammatory bowel diseases often associated with bronchiectasis Inflammatory bowel diseases then of course you're saying, Dr. Raj that this could be association with Crohn's, or maybe perhaps ulcerative colitis? This is true clinically, keep this in mind: Bronchiectasis, IBD Wat else, Prevention. Really, no perfect method of preventing.

    03:36 But you have to find the cause, once you find that cause, then it will go away so prevention is rather difficult with bronchiectasis.

    03:42 Routine chest x-ray may show clouding of bronchial marking and "Tram tracking" In other words, the membrane becoming affected.

    03:50 If the sputum sample shows pseudomonas, then at this point, Well, you're thinking about antipseudomonal immediately Next, the diagnostic study of choice is high resolution CT (HRCT) of the chest Bronchiectasis, what are you looking for? Those dilated, dilated bronchi.

    04:12 Treatment.

    04:13 Well, you should begin by looking for the underlying cause, We talked about MAI, immune deficient patients with all kinds of infections and Allergic bronchopulmonary aspergillosis Frequent antibiotics directed against the organism in the sputum but the resistance is something is what you're always worried about.

    04:30 Anyway clearance with manual percussion and then you have vest therapy, Yeah, other ways in which maybe perhaps your objective at this point is to clear, clear your airways because of the increased mucus production.


    About the Lecture

    The lecture Bronchiectasis: Differential Diagnosis by Carlo Raj, MD is from the course Obstructive Lung Disease.


    Included Quiz Questions

    1. Aspergillus fumigatus.
    2. Mycobacterium avium intercellularae.
    3. Mycobacterium tuberculosis.
    4. Choriocarcinoma metastasis.
    5. Histoplasma capsulatum.
    1. Interstitial lung disease
    2. COPD
    3. Cystic fibrosis
    4. Staphylococcal pneumonia
    5. Immunodeficiency
    1. Bronchiectasis
    2. Bronchopulmonary asthma
    3. Emphysema
    4. Interstitial lung disease
    5. Sinonasal polyps
    1. Inflammatory bowel disease
    2. Irritable bowel syndrome
    3. Colon cancer
    4. Volvulus
    5. Diverticulosis
    1. HR-CT
    2. Chest X-ray
    3. Bronchoscopy
    4. Lung biopsy
    5. MRI
    1. Tram track appearance of bronchioles
    2. Cavitation
    3. Irregular hyperdense shadows of the lung
    4. Solid well-defined mass
    5. Multiple cystic spaces

    Author of lecture Bronchiectasis: Differential Diagnosis

     Carlo Raj, MD

    Carlo Raj, MD


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