Definition
• Permanent dilatation of the cartilaginous bronchi often accompanied with inflammatory changes
Clinical features
Epidemiology
• Worldwide problem; less prominent in the United States
• Most common noninherited causes are infection (viral or bacterial), obstruction (tumor or aspiration), and allergic bronchopulmonary aspergillosis
• No age or sex predilection
• Most patients are in their mid 50s at the time of diagnosis
• Younger patient may have inherited disease, such as cystic fibrosis or primary ciliary dyskinesia or immunodeficiency syndromes (inherited or acquired)
Presentation
• Productive cough with purulent sputum, dyspnea, fever and hemoptysis
• Radiographic findings: chest X-ray film may show classic parallel linear opacities (tram tracks) corresponding to thickened bronchial walls; tubular opacities reflect mucus-filled bronchi
Prognosis and treatment
• Irreversible disease
• Treat the underlying causes of the disease (e.g., airway obstruction [tumor or foreign body], infection, or cystic fibrosis)
• Symptomatic treatment
Pathology
Histology
• Grossly dilated bronchi with scarring are filled with mucopurulent material and extend almost to the pleural surface
• Histological findings vary significantly: some cases show minimal changes and some show bronchial dilation, mucopurulent stasis, and acute and chronic inflammation
• In severe cases, the entire bronchial wall can be disrupted, including mucosa, submucosa, muscularis propria, and cartilage
Immunopathology/special stains
• Not contributory
Fig 1 Bronchiectasis. Gross photograph of cut surface of explanted lung showing dilated bronchi extending up to the pleural surface. Some of them contain purulent exudates. Middle lobe is solidified and fibrotic. Prominent anthracotic pigment is present.
Fig 2 Bronchiectasis. Lowest power (A) and low power (B) photomicrographs show dilated airways and fibrosis of adjacent lung. Note organized polypoid inflammatory tissue within the airways.
Fig 3 Bronchiectasis. There is acute and chronic inflammation and ulceration of the airway in this 3-year-old patient with postinflammatory localized bronchiectasis.