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Pediatric Bronchiectasis Workup

  • Author: Michael R Bye, MD; Chief Editor: Michael R Bye, MD  more...
 
Updated: Sep 20, 2015
 

Approach Considerations

Laboratory evaluation of bronchiectasis may 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
  • 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
  • Flexible fiberoptic bronchoscopy

Obviously, not every patient with bronchiectasis requires each of the above studies. The history and physical examination should help guide the physician in the appropriate directions.

Because bronchiectasis is defined as an abnormal dilatation of airways, the diagnosis depends on radiographically or anatomically visualizing the typical changes. In patients with suspected bronchiectasis without characteristic chest radiograph findings, a high-resolution CT (HRCT) scan is the diagnostic procedure of choice.

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Chest Radiography

Obtain a routine posteroanterior and lateral chest radiograph. A dilated airway, with thickened airway walls can be noted. When seen laterally, the bronchiectatic airway has been described as tram tracks. However, normal radiograph findings do not rule out bronchiectasis.

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Computed Tomography

The diagnosis of bronchiectasis 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.

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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 or impedance monitoring. Suspicion of poor oromotor coordination should lead to a swallow study.

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Fiberoptic Bronchoscopy

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.

A study evaluated the value of fiberoptic bronchoscopy and bronchoalveolar lavage (BAL) in indigenous children as part of the workup at the first diagnosis of bronchiectasis.[17] BAL eosinophilia was found in 34% of the children; of these, 42% were found to have positive serology to Strongyloides, which was not known beforehand. BAL microbiology led to a change in antibiotic therapy in 9%. These data suggest a larger role for bronchoscopy in the diagnosis of pediatric bronchiectasis.

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Bronchography

In the past, 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.

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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.

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Contributor Information and Disclosures
Author

Michael R Bye, MD Professor of Clinical Pediatrics, State University of New York at Buffalo School of Medicine; Attending Physician, Pediatric Pulmonary Division, Women's and Children's Hospital of Buffalo

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Charles Callahan, DO Professor, Chief, Department of Pediatrics and Pediatric Pulmonology, Tripler 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, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Charles Callahan, DO Professor, Chief, Department of Pediatrics and Pediatric Pulmonology, Tripler 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, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Chief Editor

Michael R Bye, MD Professor of Clinical Pediatrics, State University of New York at Buffalo School of Medicine; Attending Physician, Pediatric Pulmonary Division, Women's and Children's Hospital of Buffalo

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Thomas Scanlin, MD Chief, Division of Pulmonary Medicine and Cystic Fibrosis Center, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School

Thomas Scanlin, MD is a member of the following medical societies: American Association for the Advancement of Science, Society for Pediatric Research, American Society for Biochemistry and Molecular Biology, American Thoracic Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Pauline Fani, MD, to the development and writing of the source article.

References
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Posteroanterior chest radiograph of a child with bronchiectasis due to chronic aspiration.
CT scan of the chest of a child with bronchiectasis due to chronic aspiration.
Chest radiograph of a child with severe adenoviral pneumonia as an infant. The child has persistent symptoms of cough, congestion, and wheezing.
Bronchoscopic bronchogram of the left lower lobe on a patient with history of adenoviral pneumonia, demonstrating cylindrical and varicose types of bronchiectasis.
Bronchoscopic bronchogram of the right upper lobe of a patient with a history of adenoviral pneumonia, demonstrating saccular bronchiectasis.
 
 
 
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