BRONCHIECTASIS

COMPLICATIONS & DIFFERENTIAL DIAGNOSIS

JJ.JENSON

COMPLICATIONS
Hemoptysis Lung abscess Pyothorax Cor pulmonale Recurrent pnemonia Cavity formation

HEMOPTYSIS
MECHANISM: Vascular enlargement of dilated bronchial vessels resulting in the erosion of the adjacent bronchial arterioles &pulmonary capillaries results in massive hemoptysis Management:Blood transfusion,oxygen therapy

LUNG ABSCESS
Mechanism: Chronic bronchial inflammation secondary to inappropriate clearance of various micro organisms leading to infection which results in Lung abscess Organisms:Anaerobes,Staphylococci,Psuedomo nas Clinical ftrs:fever,cough with purulent sputum

Contd..
Hemoptysis may be associated Management:Application of antibiotics,postural drainage,

PYOTHORAX
Mechanism: Pus getting collected in the plueral cavity due to repeated infections leads to pyothorax Symptoms:cough,fever,chest pain,shortness of breathing Diagnosis:Pus culture&tests for antibiotic sensitvity Treatment:Thoracocentesis

CORPULMONALE
Enlargement of right ventricle with or without failure secondary to disease of lung&pulmonary circulation Clinical ftrs:Palpitation,dyspnea,edema Treatment:Diuretics,vasodilators,control of infection

RECURRENT PNEMONIA
Exudative solidification of lung tissue Causes:Foreign bodies Management:Sputum examination,blood culture,serology(mycoplasma,chlamydia) Pnuemococcal:PenicillinG 50,000 units/kg/day can be given intravenously in divided doses for a week to ten days

CAVITY FORMATION
Results due to the tuberculous involvement of bronchial wall Mechanism:it occurs in post-primary tuberculous patients due to cicatrial bronchostenosis which leads to destruction of lung parenchyma Apical&posterior segments of the upper lobe is involved

RARE COMPLICATIONS
Septicemia Amyloidosis Respiratory failure Metastatic abscess to the brain

DIFFERENTIAL DIAGNOSIS based on SYMPTOMS

COUGH WITH SPUTUM

CRACKLES

DD for COUGH WITH SPUTUM

Based on 1)Amount of sputum production 2)Colour of the sputum

Amount of Sputum
Sudden production of large amount of purulent sputum on a single occasion-rupture of lung abscess Large volume of watery sputum with a pinkish tinge-acute pulmonary edema

COLOUR&TYPE OF SPUTUM
Green,purulent sputum Pnuemonia,Cystic fibrosis Yellow,purulent sputum-Acute bronchopulmonary infection Mucoid sputum-Chronic bronchitis Pink,frothy,serous sputum-Acute pulmonary edema Rusty red sputum-Pnuemococcal pnemonia

CRACKLES
Crackles are defined as non-musical,interrupted added sounds of short duration,explosive in nature TYPES-1)Fine crackles 2)Coarse crackles Fine crackles sign of parenchymal infiltration Apex of lung-pulmonary tuberculosis Diffuse fine crackles-Pnuemonia

COARSE CRACKLES
Coarse leathery crackles heard in base of lungBronchiectasis If heard diffusely all over lung-Cysic fibrosis Bronchitis Moist bubbling crackles-pulmonary edema

INSPIRATORY CRACKLES
Early inspiratory crackles-Bronchiolitis Mid inspiratory crackles-Bronchiectasis Late inspiratory crackles-pulmonary edema EXPIRATORY CRACKLES-chronic bronchitis

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