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Transcript of Bronchial syndrome Atelectasis Draining bronchus Bronchiectasis Etienne Leroy Terquem – Pierre...
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Bronchial syndrome
Atelectasis Draining bronchusBronchiectasis
Etienne Leroy Terquem – Pierre L’HerSPI / ISP
Soutien Pneumologique International / International Support for Pulmonology
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Atelectasis
Consequence of the obstruction of a bronchus
intrinsic (tumor, foreign body, inflammatory stenosis)
or extrinsic (compression by adenopathy or tumor)
The alveolar air gradually disappears and the lung tissue is retracted.
The retraction can involve one segment, one lobe or the whole lung
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Main etiologies of atelectasis• Bronchial cancer • Tuberculosis• Extrinsic compression by adenopathy TB (++ children) or malignant • Foreign body (+ + + young children, not always Radio opaque)
Less common causes:Asthma Chronic bronchitisViral or bacterial pneumoniaAtelectasis after thoracic or abdominal surgery, after traumaMany other rare etiologies: benign tumor, endobronchial metastasis,
lymphoma, granulomatous inflammation regardless of etiology, bronchiolitis, cystic fibrosis, ...
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The radiographic appearance is an opacity, like a consolidation but:
Systematized (in contact with a fissure)
Retractile (decrease volume)
Homogeneous Without air bronchogramWith a variable size: a segment, a lobe, the lung
ATELECTASIS
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M 59 y. Hemoptysis
Smoking = 40 pack-years
AFB sputum negative
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Atelectasis of the right upper lobeM 59 y. Hemoptysis
Smoking = 40 pack-years
AFB sputum negative Endoscopy: neoplastic bud in the RUL bronchus
Small fissure in the normal position, horizontal, in pneumonia
Ascension of the small fissure = Retraction of RUL
Cancer
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Male,75 years old, smoker, chronic cough and one episode of hemoptisis
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Right lower lobe atelectasis by bronchial cancer
Male,75 years old, smoker, chronic cough and one episode of hemoptisis
Retractile opacity who does not erase the edge of the heart
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Middle lobe atelectasis
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Partial atelectasis of the right superior lobe by cancer
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Man, 56 years old. High fever, right abdominal and thoracic pain, Muscular defense of the right hypochondrium,
X-ray: Middle lobe atelectasis
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Liver abcess: the reduction of right hemidiaphragm mobility leads to atelectasis above the diaphragm
«passive atelectasis»
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Smoker 60 pack-years. Hemoptysis, thoracic pain and dyspnea AFB sputum negative
Left upper lobe atelectasis by cancer
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RUL consolidation by cancer Atelectasis in the process of constitution
A.Khallil and coll. EMC 386 C10 2005
Notice the association with a big hilar round mass
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Smoker 40 pack-years HemoptisisLeft anterior thoracic pain and cough.
Recent weight loss & asthenia - AFB sputum negative
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Left upper lobe atelectasis by cancer
Smoker 40 pack-years HemoptisisLeft anterior thoracic pain and cough.
Recent weight loss & asthenia - AFB sputum negative
Fissure
Retraction of LUL
Notice the round mass on the left hilus
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Atelectasis + round hilar mass:
In adults = most often cancer
In children = most often TB
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1 year old child
TB primary
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1 year old child
Bilateral adenopathies, Left lower lobe atelectasis : compression of the left inferior bronchus by mediastinal adenopathies
TB primary
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But not always… Look for AFB in sputum systematiquely
Cancer
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W 37 years old, cough and dyspnea.
AFB +
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Classic retractile evolution with TB treatment
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Opacity of the whole left lung fieldDo you think this is an atelectasis of the left lung?
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Opacity of the whole left lung fieldDo you think this is an atelectasis of the left lung?
No The mediastinum is
pushed by the opacity=
Great abundancepleurisy
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Whole left lung atelectasis
Retraction
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Atelectasis
Retraction
Pushing back
Compressive pleural effusion
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Draining bronchus-TB cavern +++- bacterial nonTB abcess +/-
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Small TB cavern with a draining bronchusassociated with a lower lobe TB pneumonia
Silhouette signOpacity does not erasethe left side of the heart
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TB cavityNotice the draining bronchus and right axillar infiltrate
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Bronchiectasis
Bronchial disease characterized by a permanent increase in bronchial caliber
The cartilaginous framework of the bronchial wallis destroyed or broken up
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Barker A. N Engl J Med 2002;346:1383-1393
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Located •Pulmonary TB•Bacterial / viral infection in children (measles, whooping cough ..)
•Foreign body•Bronchial stenosis, extrinsic compression(adenopathy)•Diffuses•Bacterial or viral infection in children (measles, whooping cough ..)•TB•Cystic fibrosis•Other congenital diseases: Situs inversus, Imotile cilia Syndrome•Dysglobulinemia, chronic immune deficiency, autoimmune diseases ...
Bronchiectasis: etiologies
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• Bronchopulmonary infections repeated• Hemoptysis • Significant, Chronic and often purulent
sputum, with AFB negative• Frequent history of TB or• Severe respiratory infection in early
childhood
Bronchiectasis: clinical features
Bronchiectasis is a frequent and underestimated pathology, especially in countries with high incidence of TB and
childhood lung diseases
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Bronchiectasis radiological features
• Round or cylindric images (clarity with thick or thin wall)
• Sometimes with fluid level if active infection• Localized in a lobe or a segment, or diffuse
The lipiodol bronchographyis replaced by the scanner
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Bronchectasis (opacification with iodin hydrosoluble solution)
“AmpullarySaccular“
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Bronchiectasis(opacification with iodin hydrosoluble solution)
“Cylindrical“
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Typical railway picture in middle lobe & RLL with associated round cavities : Bronchiectasis
W. chronic cough with morning abundant sputum. Repeted bronchial infections and frequent antibiotic treatments.
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Railway picture : Middle lobe bronchiectasis
Another case
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Railway picture : Middle lobe bronchiectasis
With CT scan the diagnosis is obvious. Bronchography is not available now, you don’t have scanner. You must be able to identifyBronchiectasis on CXR
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Unilateral bronchiectasis of the left lower lobe
Chronic purulent sputum
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Bilateral bronchiectasis
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Digital hippocratism is often associated with
bronchiectasis
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Female, 25 y, chronic cough and purulent sputum * Measles at the age of 6 years
* Bronchorrhea
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Young woman, 20 y, repeated bronchus infections from a very early age, and gradual respiratory insufficiency
MUCOVISIDOSIS (1 case/ 2000 births in Europa)
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Right severe bronchiectasis, Retractile sequela of extensive TB of the right lung
CXR from Lao TBPrevalence survey
Bronchiectasis is very frequent and underestimated, in countries
with high TB incidence
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Dilation of bronchus, Bronchiectasis is a common disease with many etiologies:Sequelae of TBEffects of early childhood infections (Measles + + +, pertussis),Congenital malformations (rare)Not to be confused with TB cavitations
Bronchial syndromeYou must be able to identify Atelectasis Draining bronchusBronchiectasis