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
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Posteroanterior chest radiograph of a child with bronchiectasis due to chronic aspiration.
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CT scan of the chest of a child with bronchiectasis due to chronic aspiration.
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Chest radiograph of a child with severe adenoviral pneumonia as an infant. The child has persistent symptoms of cough, congestion, and wheezing.
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Bronchoscopic bronchogram of the left lower lobe on a patient with history of adenoviral pneumonia, demonstrating cylindrical and varicose types of bronchiectasis.
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Bronchoscopic bronchogram of the right upper lobe of a patient with a history of adenoviral pneumonia, demonstrating saccular bronchiectasis.
