eMedicine Specialties > Pediatrics: General Medicine > Pulmonology

Bronchiectasis: Differential Diagnoses & Workup

Author: Michael R Bye, MD, Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center
Coauthor(s): Pauline Fani, MD, Fellow, Department of Pediatrics, Division of Pulmonary Medicine, Columbia University Children's Hospital; Charles Callahan, DO, Professor, Deputy Chief of Clinical Services, Walter Reed Army Medical Center
Contributor Information and Disclosures

Updated: Sep 8, 2009

Workup

Laboratory Studies

Laboratory evaluation of bronchiectasis should include the following tests:

  • Sweat chloride
  • With underlying asthma or cystic fibrosis (CF), evaluation for allergic bronchopulmonary aspergillosis should include immunoglobulin E (IgE) and serum precipitins for Aspergillus species , sputum culture for fungus, and an aspergillus skin test
  • CBC count
  • Serum immunoglobulin G (IgG), immunoglobulin M (IgM), and IgA
  • IgG subclasses
  • HIV test
  • Sputum culture or deep oropharyngeal swab in younger children
  • Ciliary biopsy
  • Antinuclear antibody and rheumatoid factor

Imaging Studies

Because bronchiectasis is defined as an abnormal dilatation of airways, the diagnosis depends on radiographically or anatomically visualizing the typical changes.

  • Chest radiography: Obtain a routine posteroanterior and lateral chest radiograph. However, normal radiograph findings do not rule out bronchiectasis. A dilated airway, with thickened airway walls can be noted. When seen laterally, the bronchiectatic airway has been described as tram tracks.
  • CT scanning
    • The diagnosis is usually established using high-resolution CT (HRCT) scanning, which has a sensitivity and specificity of more than 90%.
    • The key feature on HRCT scanning is an enlarged internal bronchial diameter with bronchi that appear larger than the accompanying artery, called the signet sign. Other HRCT scan findings include the failure of the larger airways to taper while progressing to the lung periphery, air fluid levels in the dilated airways, and the identification of airways in the extreme lung periphery.
  • Gastroesophageal reflux disease assessment
    • Evaluate patients suspected of having bronchiectasis for gastroesophageal reflux disease, especially infants and young children.
    • Studies may include barium esophagraphy, gastric scintiscanning, and intraesophageal pH monitoring.
    • Suspicion of poor oromotor coordination should lead to a swallow study.

Procedures

  • Fiberoptic bronchoscopy may help assess the caliber and appearance of the airways and provide bronchoalveolar lavage fluid for evidence of chronic aspiration or infection. Significant numbers of lipid-laden macrophages or significant amounts of pepsin or amylase may suggest recurrent aspiration.
  • Fluoroscopically guided selective bronchography, using water-soluble contrast media and performed by an experienced bronchoscopist, provided excellent anatomic definition. This study has been virtually eliminated by CT scanning.

Histologic Findings

  • Examination of the bronchoalveolar fluid reveals inflammatory cells.
  • Hemosiderin-laden macrophages generally suggest nonacute bleeding.
  • Lipid-laden macrophages suggest chronic aspiration but may also be observed in other forms of severe airway disease.

More on Bronchiectasis

Overview: Bronchiectasis
Differential Diagnoses & Workup: Bronchiectasis
Treatment & Medication: Bronchiectasis
Follow-up: Bronchiectasis
Multimedia: Bronchiectasis
References
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References

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Further Reading

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Keywords

bronchiectasis, bronchiectasia, destruction of airways, inflammation of the airway, bronchial dilatation, cystic fibrosis, CF, tuberculosis, pneumonia, cylindrical bronchiectasis, varicose bronchiectasis, saccular bronchiectasis, focal bronchiectasis, diffuse bronchiectasis, human immunodeficiency virus, HIV, primary ciliary dyskinesia, adenovirus, measles, Mycobacterium avium, or Aspergillus fumigatus, recurrent pneumonia, bronchitis, asthma, gastroesophageal reflux disease, allergic bronchopulmonary aspergillosis, pertussis, tracheoesophageal fistula, Marfan syndrome, Bruton agammaglobulinemia, Mounier-Kuhn syndrome, Williams-Campbell syndrome, connective tissue disorder, rheumatoid arthritis, systemic lupus erythematosus, treatment, diagnosis

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Contributor Information and Disclosures

Author

Michael R Bye, MD, Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center
Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society
Disclosure: Merck Honoraria Speaking and teaching

Coauthor(s)

Pauline Fani, MD, Fellow, Department of Pediatrics, Division of Pulmonary Medicine, Columbia University Children's Hospital
Pauline Fani, MD is a member of the following medical societies: American College of Chest Physicians
Disclosure: Nothing to disclose.

Charles Callahan, DO, Professor, Deputy Chief of Clinical Services, Walter Reed Army Medical Center
Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

Medical Editor

Thomas Scanlin, MD, Chief, Division of Pulmonary Medicine and Cystic Fibrosis Center, Department of Pediatrics, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School
Thomas Scanlin, MD is a member of the following medical societies: American Association for the Advancement of Science, American Society for Biochemistry and Molecular Biology, American Thoracic Society, Society for Pediatric Research, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Charles Callahan, DO, Professor, Deputy Chief of Clinical Services, Walter Reed Army Medical Center
Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

CME Editor

Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Professor of Clinical Pediatrics, State University of New York at Stony Brook; Director of Children's Sleep Services, Winthrop University Hospital
Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians
Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Michael R Bye, MD, Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center
Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society
Disclosure: Merck Honoraria Speaking and teaching

 
 
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