支气管扩张：放射科医生病因诊断指南

The Aftermath of Bronchiectasis: A Radiologist's Guide to Finding Answers

Pratik P Patel MD, Sagar B Amin MD, Nupur Verma MD, Tan-Lucien H Mohammed MD FCCP

University of Florida

Department of Radiology, Gainesville, FL

Radiological Society of North America

Annual meeting 2017

Chicago, IL

Teaching Points

· Review the pathophysiology of bronchiectasis.

· Outline the imaging findings of bronchiectasis including the characteristic distribution patterns and secondary findings.

· Provide a pictorial case review of bronchiectasis to illustrate a comprehensive differential.

· Discuss and update the clinical evaluation and management for various causes of bronchiectasis.

What is Bronchiectasis?

Respiratory tract infection  Bronchial inflammation  Respiratory tract damage  Impaired mucociliary clearance system  Progressive lung disease bronchiectasis Microbial insults Defect in the host defense

· Defined by the presence of permanent and abnormal dilation of the bronchi.

· End result of a wide variety of processes causing chronic airway damage.

· Pathophysiology: Cole’s generally accepted “vicious cycle” hypothesis.

Distribution Patterns

Anterior Predominance 

Atypical Mycobacterial Infection (M. avium-intracellulare infection -MAI) 

Acute Respiratory Distress Syndrome (ARDS)

Upper or Mid Lung Predominance  

Cystic Fibrosis (CF) 

Sarcoidosis 

Tuberculosis (TB) 

Allergic Bronchopulmonary Aspergillosis (ABPA)

Diffuse 

Bronchiolitis Obliterans (including graft-versus-host disease)

Lower Lung Predominance  

a1-Antitrypsin Deficiency 

Primary Ciliary Dyskinesia 

Chronic Aspiration 

Pulmonary Fibrosis (NSIP/UIP)  

Immunodeficiency (such as Common VariableImmune Deficiency -CVID)

Focal  

Swyer-James Syndrome  

Radiation-induced lung disease  

Bronchial atresia  

Pulmonary sequestration  

Endobronchial or PeribronchialTumors

Central Predominance  

Tracheobronchomegaly (Mounier-Kuhn syndrome)  

Williams-Campbell Syndrome (Case not included)