Diagnostic Considerations

In addition to the history, the differentials for bronchiectasis can be narrowed down based on the distribution of bronchiectasis on high resolution chest CT scan. A more focal distribution is more consistent with foreign body, endo-bronchial neoplasm, or congenital bronchial atresia. A more diffuse distribution of bronchiectasis particularly in bilateral upper lobes tends to be associated with sarcoidosis, pneumoconiosis, cystic fibrosis, allergic bronchopulmonary aspergillosis, and traction bronchiectasis cause by tuberculosis and postradiation fibrosis.

Hypogammaglobulinemia, primary ciliary dyskinesia, chronic aspiration, nonspecific pneumonitis, idiopathic and postinfectious bronchiectasis have a propensity for diffuse lower lobe distribution. The right middle lobe and lingula are more commonly involved in primary ciliary dyskinesia, atypical mycobacterial infections and Kartagener syndrome.

With a good history, exam, knowledge of common etiologies and distribution on CT scan, the diagnostic approach can be streamlined.

Differential Diagnoses

Workup

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Media Gallery

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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Author

Kristen N Miller, MD Assistant Professor of Clinical Pediatrics, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania; Attending Physician, Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia

Kristen N Miller, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Coauthor(s)

Marianna M Sockrider, MD, DrPH Professor of Pediatric Pulmonology, Department of Pediatrics, Baylor College of Medicine; Chief of Pulmonary Clinics, Texas Children's Hospital

Marianna M Sockrider, MD, DrPH is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, Harris County Medical Society, Texas Medical Association

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

Girish D Sharma, MD, FCCP, FAAP Professor of Pediatrics, Rush Medical College; Director, Section of Pediatric Pulmonology and Rush Cystic Fibrosis Center, Rush Children's Hospital, Rush University Medical Center

Girish D Sharma, MD, FCCP, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, Royal College of Physicians of Ireland

Disclosure: Nothing to disclose.

Additional Contributors

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.

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.

Pediatric Bronchiectasis Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

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