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BRONCHIECTASIS
- Question:
- What is your diagnosis ??
- Answer:
- A case of bronchiectasis secondary to chronic bronchitis.

- Question:
- Why ??
- Answer:
- Because:
1. History: history suggestive of chronic bronchitis, followed by:
history suggestive of bronchiectasis in the form of:
“ Long history of suppurutive lung syndrome where there was ”:

- Persistent recurrent cough with expectoration of suptum which is:

 Excessive.
 Mucorpurulent.
 Foetid.
 Increases in the morning & on leaning forwards.
- Onset was gradual & the course was progressive over years with characteristic winter
exacerbations.

2. General Examination:
a) Toxic face.
b) Puffy eye lids due to chronic cough.
c) Clubbing of the fingers due to chronic toxemia.
d) Oedema of lower limbs due to cor pulmonale & RVF.

3. Local Examination:
- In the basal parts: there are signs of consolidation & may be
fibrosis.
- In the upper parts: normal or signs of emphysema.

Inspection:
- Shape: Normal shape of the chest in the basal parts.
Barrel chest in the upper parts.
- Respiratory movements: Diminished, mainly in the basal parts.

Palpation:

- Trachea & mediastinum: Central.

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- TVF: Increased on the basal parts.

Decreased on the upper parts.

Percussion:
- Patchy dullness on the basal parts.
- Hyper-resonance on the upper parts.

Ausculation:
- Basal Parts:
 Breath sound: Patchy areas of bronchial breathing ( with aegophony,
whispering …)
 Additional sounds: Medium-sized or coarse crepitations.

- Upper parts:
 Breath sound: Vesicular breathing with prolonged
expiration.
 Additional sounds: Rhonchi.

- Question:
- What are the other causes of coarse crepitations ??
- Answer:
- Acute pulmonary oedema, lung abscess, late stage of pneumonia ( stage of resolution ).

- Question:
- What are the other causes of bilateral basal crepitations ??
- Answer:
- Fine bilateral basal crepitations in case of LVF ( pulmonary congestion ).

- Question:
- What is the DD of this case ??
- Answer:

A. Causes of suppurative syndrome; which is defined as:

“ Cough with expectoration of excessive purulent foeted sputum, usually related to posture ”:

1. Lung abscess:
- Acute onset , no periodicity.
- Expectoration increases on lying on the healthy side.
- Signs are localized, & Chest X-ray reveals a cavity.

2. Bronchiectasis:
- Gradual onset, periodicity ( more in winter , more in the morning ).
- Expectoration increases on leaning forwards.
- Signs are bilateral & basal, & Chest X-ray reveals honey-combing.

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3. Infected cystic lung:

- Signs of bronchiectasis since birth or in early childhood.
- Chest X-ray reveals soap-bubble appearance.

4. Empyema with broncho-pleural fistula:

- Signs of pyopneumothorax.

B. Causes of hemoptysis.

- Question:
- What is the most important investigation for this patient ??
- Answer:

CT chest: ( the most important investigation )

- It provides excellent visualization of the bronchiectatic airways.
- It localizes the site & extent of bronchiectasis before surgery.