Today we learned about a patient who presented with hemoptysis in the setting of latent TB that was diagnosed as TB Bronchiectasis. We discussed the framework for hemoptysis:

We then reviewed the CT and determined it was bronchiectasis:

• Bronchioectasis is defined as “Irreversible dilation and destruction of larger bronchi caused by chronic infection and inflammation”
• Development of bronchiectasis always requires two factors
  • An infectious insult
  • Impaired drainage, airway obstruction or a defect in host defense
• Etiologies
  • Any pulmonary Infections
    • Childhood infections (bacterial, viral or mycoplasma PNA)
    • Mycobacterial infections
  • Cystic Fibrosis
    • up to 7 percent of patients with cystic fibrosis (CF) are diagnosed at age 18 years or older
    • Sinusitis and bronchiectasis are the major respiratory manifestations of CF in adults
  • Airway obstruction
    • FBA or any other intraluminar obstructing lesion (such as a carcinoid tumor) or extraluminal compression
  • Tracheobronchomalacia/tracheobronchomegaly
  • Defective host defenses
    • Local: Ciliary dyskinesia
    • Systemic: hypogammaglobulinemia/prolonged immunosuppression
  • Young Syndrome
    • Bronchiectasis, sinusitis and obstructive azoospermia who have no evidence of cystic fibrosis
  • Rheumatic/Systemic Disease
    • RA/Sjogrens
  • Primary Ciliary Dysfunction
  • Allergic bronchopulmonary aspergillosis
    • should be suspected in patients with a long history of asthma that is resistant to bronchodilator therapy and associated with a cough often productive of sputum that is mucopurulent or contains mucous plugs.
  • Alpha-1 antitrypsin deficiencies
• Signs and Symptoms
  • cough, mucopurulent sputum production, dyspnea, rhinosinusitis, hemoptysis (27%) and recurrent pleurisy
  • on exam crackles and wheezing are common
• Radiographic Findings
  • The internal diameter of the bronchus is larger than that of its accompanying vessel
  • the bronchus fails to taper in the periphery of the chest
• Treatment of Acute Exacerbation
  • Deciding when a patient has an acute exacerbation requires clinical judgement as there is no laboratory features specific for an exacerbation
  • Antibiotics decrease the existing bacterial burden and can decrease systemic inflammatory mediators
  • 10-14 day treatment course is appropriate (though the ERS 2017 guidelines suggest 14)