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Man with persistent cough.

Our appreciation is extended to Dr. Wei-Shin Wang,
Indiana University Department of Radiology,
for contributing this case.

History:  Man with persistent cough.


Review the CXR below. Which choice best characterizes the salient finding(s), if any?

Cavitary lung disease.Basilar-predominant pulmonary fibrosis.Scattered scarring, otherwise unremarkable.Micronodular pattern.Within normal limits.Image
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Man with persistent cough.

Here are some CT images of the same patient. Click to enlarge.

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Which choice best describes the predominant abnormal finding (which was not apparent on CXR)?

Cystic lung disease.Cystic adenomatoid malformation.Septic emboli.Bronchiectasis.Stigmata of sarcoid.
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Man with persistent cough.

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Findings:  Varicose and cystic bronchiectasis involving the upper and lower lobes bilaterally with sparing of the right middle lobe. Bronchiectasis not apparent on the chest x-ray.


Differential diagnosis:

  • Allergic bronchopulmonary aspergillosis
  • Toxic inhalation
  • Cystic fibrosis
  • Langerhans cell histiocytosis
  • Chronic bronchitis
Diagnosis:  Diffuse bronchiectasis, etiology unknown
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Man with persistent cough.


Key points:
 

  • Bronchiectasis is the irreversible dilation of the bronchial wall.
  • Usual Bronchial to arterial ratio is < 1. If ratio is greater than 1.5, bronchiectasis should be suspected.
  • There are three types of bronchiectasis: cylindrical, varicose and saccular
  • Cylindrical bronchiectasis = uniform diameter of dilated bronchus.
  • Varicose bronchiectasis = String of pearls morphology is alternating stenosis and dilation.
  • Saccular bronchiectasis = Cluster of grapes morphology with rounded dilation of bronchus
  • There are innumerable causes of bronchiectasis. The more common causes are cystic fibrosis, recurrent infections, allergic bronchopulmonary aspergillosis, tuberculosis.

References: 

  1. Grenier, P., et al. Bronchiectasis: assessment by thin-section CT. October 1986 Radiology, 161,95-99.
  2. Perera, P.L. and Screaton, N.J. Radiologic features of bronchiectasis. Haworth. European Respiratory Society Monograph, Vol. 52. 2011.
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Man with persistent cough.


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