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 Definition
• Bronchiectasis is a congenital or
acquired disorder of the large bronchi
characterized by permanent, abnormal
dilation and destruction of bronchial
walls.
• It may be caused by recurrent
inflammation or infection of the airways
• May be localized or diffuse.
• Cystic fibrosis causes about half of all
cases of bronchiectasis. 3
 Etiology
Other causes include
• lung infections (tuberculosis and nontuberculous
mycobacteria, fungal infections, lung abscess, pneumonia)
• immunodeficiencies (congenital or acquired
hypogammaglobulinemia; common variable
immunodeficiency; selective IgA, IgM, and IgG subclass
deficiencies; AIDS; lymphoma; plasma cell myeloma;
leukemia)
• alpha-1- antitrypsin deficiency
• primary ciliary dyskinesia
• rheumatic diseases (rheumatoid arthritis, Sjögren
syndrome);
• allergic bronchopulmonary aspergillosis (ABPA)
• localized airway obstruction (foreign body, tumor, mucoid
impaction). 4
 Predisposing Factors
• Congenital disorders
• Immune deficiencies
• Hypogammaglobulinemia
• Immunoglobulin A (IgA) deficiency
• Cystic fibrosis

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 Pathophysiology & Pathology
• In bronchiectasis, there are impaired airway clearance
mechanisms and host defenses, resulting in an inability
to clear secretions, which predisposes patients to chronic
infection and inflammation.
• As the result of frequent infections, most commonly
with H. influenzae (35%), Pseudomonas aeruginosa (31%),
Moraxella catarrhalis (20%), S. aureus (14%), and S.
pneumoniae (13%), airways become inspissated with
viscous mucus-containing inflammatory mediators and
pathogens.
• The airways slowly become dilated, scarred, and
distorted.
• Histologically, bronchial walls are thickened by edema,
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inflammation, and neovascularization.
 Clinical Features
• Common
• Chronic cough productive of purulent sputum
• Recurrent chest colds or pneumonias
• Occasional hemoptysis
• Pleuritic pain
• These symptoms cannot be differentiated from those of chronic
suppurative bronchitis
• Advanced
• Progressive dyspnea
• Cyanosis
• Digital clubbing
• Cor pulmonale

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 Diagnosis
• Mutation analysis of CFTR gene
• alpha-1-antitrypsin level
• Sputum culture for bacteria
• Physical examination reveals rales over the
area of involvement on repeated examinations.
• Pulmonary function testing produces normal
results in mild cases, but in moderate or severe
cases it may reveal either restrictive or a mixture
of restrictive and obstructive ventilatory
patterns.
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 Diagnosis
• Chest radiography shows peri bronchial fibrosis
in the involved segment.
• Segmental lung collapse in areas of
bronchiectasis is common.
• CT scanning, particularly high-resolution
computed tomography (HRCT), is the definitive
method for diagnosing bronchiectasis.
• Traction bronchiectasis in pulmonary fibrosis
may appear on CT scan as dilated bronchi but is
not caused by suppurative infections.
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 Complications
• Cor pulmonale
• Massive hemoptysis
• Abscess formation

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 Treatment
• Medical treatment
antibiotic therapy for 10–14 days is appropriate. Common
medications include amoxicillin or amoxicillin-clavulanate,
ampicillin, a second- or third-generation cephalosporin,
doxycycline, azithromycin, or a fluoroquinolone.
• Bronchodilator therapy
– It may be effective in some patients.
• Oxygen therapy
– It is appropriate if PaO2 levels are depressed.
• Surgical resection
– It may be helpful in localized disease.
preventive macrolide therapy for 6–12 months has been
found to decrease the frequency of exacerbations.
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Lung Abscess

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 Definition
• Lung abscess—necrosis and cavitation of the lung
following microbial infection
• can be categorized as primary (∼80% of cases) or
secondary;
• Alternatively, it can be categorized as acute (<4–6
weeks in duration) or chronic (∼40% of cases).
• Primary lung abscesses usually arise from aspiration
(including anaerobic organisms and microaerophilic
streptococci)
• Secondary lung abscesses arise in the setting of an
underlying condition (e.g., a postobstructive process,
an immunocompromising condition)
– Gram-negative rods are most common 13
 Etiology
• A solitary (single) lung abscess most commonly
results from aspiration of secretions from the
oropharynx.
• Other , less common causes include:
• Bronchial obstruction (e.g., from neoplasm)
• Bacterial pneumonia
• Pulmonary embolism with infarction
• Trans-diaphragmatic spread from intra
abdominal infections
• Chest trauma
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• Bacteremic infection
 Pathology & Pathophysiology
• Bacteria and poly morpho nuclear white
blood cells accumulate in the parenchyma,
create tissue destruction, and wall off a
cavity or “abscess.”

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 Clinical Features
• Initial symptoms are similar to those of acute
pneumonia, including:
• Fever
• Cough
• Purulent, foul-smelling sputum production
• Chronically, lung abscess is associated with
constitutional symptoms that include:
• Weight loss
• Low-grade fever
• Fatigue
• Malaise
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 Diagnosis
• Physical examination
• It may reveal relatively normal findings,
although there is occasionally clubbing of
the nail beds.
• There may be bronchial breath sounds or
crackles.
• Pulmonary function testing
• It is usually not affected by a lung abscess.

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 Diagnosis
Chest x-ray and CT scanning
• They make the diagnosis of a lung abscess:
• Irregularly shaped cavity with an air–fluid level inside.
• The cavity may be thin walled (suggesting a primary
suppurative lung abscess) or thick walled (suggesting
cavitary carcinoma with or without overriding infection).
Bronchoscopy
• if there is concern for malignancy or foreign body,
bronchoscopymay be indicated.

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 Treatment
• Treatment depends on the presumed or established etiology.
• For primary lung abscesses, the recommended regimens are
clindamycin (600 mg IV tid) or an IV-administered β-
lactam/β-lactamase combination.
• After clinical improvement, the pt can be transitioned to an
oral regimen (clindamycin, 300 mg qid; or
amoxicillin/clavulanate).
• In secondary lung abscesses, antibiotic coverage should be
directed at the identified pathogen.
• Continuation of oral treatment is recommended until imaging
shows that the lung abscess has cleared or regressed to a small
scar.
• If fever ≥7 days after antibiotic require surgical resection or
percutaneous drainage of the abscess. 19
 END
Thanks from your
nice Attention

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