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.
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.
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.
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.
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.
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.
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.
Sirmali M, Turut H, Kisacik E, et al. The relationship between time of admittance and complications in paediatric tracheobronchial foreign body aspiration. Acta Chir Belg. Nov-Dec 2005;105(6):631-4. [Medline].
Clark NS. Bronchiectasis in childhood. Br Med J. Jan 12 1963;5323:80-8. [Medline].
Weycker D, Edelsberg J, Oster G, Tino G. Prevalence and economic burden of bronchiectasis. Clin Pulm Med. 2006;12:205.
Callahan CW. Bronchiectasis: abated or aborted?. Respiration. May-Jun 2005;72(3):225-6. [Medline].
Redding G, Singleton R, Lewis T, Martinez P, Butler J, Stamey D. Early radiographic and clinical features associated with bronchiectasis in children. Pediatr Pulmonol. Apr 2004;37(4):297-304. [Medline].
Field CE. Bronchiectasis. Third report on a follow-up study of medical and surgical cases from childhood. Arch Dis Child. Oct 1969;44(237):551-61. [Medline].
Twiss J, Metcalfe R, Edwards E, Byrnes C. New Zealand national incidence of bronchiectasis "too high" for a developed country. Arch Dis Child. Jul 2005;90(7):737-40. [Medline]. [Full Text].
Karadag B, Karakoc F, Ersu R, et al. Non-cystic-fibrosis bronchiectasis in children: a persisting problem in developing countries. Respiration. May-Jun 2005;72(3):233-8. [Medline].
Morrissey BM, Harper RW. Bronchiectasis: sex and gender considerations. Clin Chest Med. Jun 2004;25(2):361-72. [Medline].
Field CE. Bronchiectasis in childhood. I. Clinical survey of 160 cases. Arch Dis Child. 1949;4:21-46.
Twiss J, Stewart AW, Byrnes CA. Longitudinal pulmonary function of childhood bronchiectasis and comparison with cystic fibrosis. Thorax. May 2006;61(5):414-8. [Medline].
Akalin F, Koroglu TF, Bakac S, Dagli E. Effects of childhood bronchiectasis on cardiac functions. Pediatr Int. Apr 2003;45(2):169-74. [Medline].
Tsao PC, Lin CY. Clinical spectrum of bronchiectasis in children. Acta Paediatr Taiwan. Sep-Oct 2002;43(5):271-5.
Lai SH, Wong KS, Liao SL. Clinical analysis of bronchiectasis in Taiwanese children. Chang Gung Med J. Feb 2004;27(2):122-8. [Medline].
Edwards EA, Metcalfe R, Milne DG, Thompson J, Byrnes CA. Retrospective review of children presenting with non cystic fibrosis bronchiectasis: HRCT features and clinical relationships. Pediatr Pulmonol. Aug 2003;36(2):87-93. [Medline].
Evans DJ, Bara AI, Greenstone M. Prolonged antibiotics for purulent bronchiectasis. Cochrane Database Syst Rev. 2003;CD001392. [Medline].
Davies G, Wilson R. Prophylactic antibiotic treatment of bronchiectasis with azithromycin. Thorax. Jun 2004;59(6):540-1. [Medline].
Anwar GA, Bourke SC, Afolabi G, et al. Effects of long-term low-dose azithromycin in patients with non-CF bronchiectasis. Respir Med. Oct 2008;102(10):1494-6. [Medline].
[Guideline] Rosen MJ. Chronic cough due to tuberculosis and other infections: ACCP evidence-based clinical practice guidelines. Chest. Jan 2006;129(1 Suppl):197S-201S. [Medline].
Otgun I, Karnak I, Tanyel FC, et al. Surgical treatment of bronchiectasis in children. J Pediatr Surg. Oct 2004;39(10):1532-6. [Medline].
Beirne PA, Banner NR, Khaghani A, Hodson ME, Yacoub MH. Lung transplantation for non-cystic fibrosis bronchiectasis: analysis of a 13-year experience. J Heart Lung Transplant. Oct 2005;24(10):1530-5. [Medline].
Kellett F, Redfern J, Niven RM. Evaluation of nebulised hypertonic saline (7%) as an adjunct to physiotherapy in patients with stable bronchiectasis. Respir Med. Jan 2005;99(1):27-31. [Medline].
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