Pediatric Bronchiectasis Workup
- Author: Michael R Bye, MD; Chief Editor: Michael R Bye, MD more...
Laboratory evaluation of bronchiectasis may include the following tests:
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
Sputum culture or deep oropharyngeal swab in younger children
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.
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.
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 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. 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.
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.
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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