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2020

ANUÁRIO DO HOSPITAL
DONA ESTEFÂNIA

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BRONCHIECTASIS - A PATTERN-BASED APPROACH TO DIFFERENTIAL DIAGNOSIS

Rita Prata1,2, Carina Ruano3, Otília Fernandes3, Luísa Figueiredo3

1 - Radiologia, Hospital Central do Funchal, Funchal, Madeira, Portugal
2 - Radiologia, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
3 - Radiologia, Hospital Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa

Rreunião internacional
- Interstitial Lung Disease - Multidisciplinary Meeting – 2019
- 11-12 Outubro 2019

Introduction: Bronchiectasis consist of an irreversible dilatation of the bronchial lumen in relation to the accompanying pulmonary artery. Classical radiological signs to identify bronchiectasis include “tram track” sign and “signet ring” sign. A significant proportion (40-50%) of bronchiectasis are idiopathic. However, many are associated with infections or, less frequently, to bronchial structural defects. When bronchial injury persists they may assume, progressively, a cylindrical, varicose and sacular / cystic deformity. Besides central obstruction, persistent inflammation and abnormal mucus production or clearance, fibrosis also plays an important role in forming bronchiectasis (traction bronchiectasis). Also, bronchial dilatation predisposes to stasis and, hence, a vicious cycle of infections/inflammation with production of sputum or even hemoptysis. When infection is present there is usually bronchial wall thickening and/or air-fluid levels (“wet” bronchiectasis).
Methods: Using a pattern and distribution based classification, we present a series of computed tomography and x-ray images illustrating diffuse vs focal distribution; central vs peripheral; upper vs lower lobes bronchiectasis and discuss their differential diagnosis. We also emphasise clinical or ancillary radiological findings that might narrow the differential diagnosis.
Results: Cystic fibrosis related bronchiectasis are most commonly central or located on the superior lobes. Lower lobe bronchiectasis might be a sign of primary ciliary dyskinesia, and, when in conjunction with sictus inversus, with Kartagener syndrome. In middle age women, non-tuberculosis mycobacterium infection may present as middle lobe bronchiectasis. A finger in glove appearance on the superior lobe may be found in allergic bronchopulmonary aspergillosis.
Conclusion: knowledge of the typical distribution of bronchiectasis and associated clinical and radiological findings aids in providing their differential diagnosis.

Palavras Chave: bronquiectasias, pediatria, tórax