Bronchiectasis Imaging

Back

Overview

Bronchiectasis is irreversible, abnormal dilatation of the bronchi.[1] Common etiologies for bronchiectasis are congenital abnormalities, recurrent infection, and airway obstruction. The tethering effect of pulmonary fibrosis can also dilate the airways, causing traction bronchiectasis.[2, 3] Involved bronchi are dilated, inflamed, and easily collapsible, resulting in airflow obstruction and impaired clearance of secretions.  Bronchiectasis typically presents with cough, sputum production, and airway obstruction,[4]  and in severe cases, massive hemoptysis can lead to death.[1]

In bronchiectasis, damaged epithelium impairs removal of mucus and increases the risk of infection by pathogens such as Pseudomonas aeruginosa, Haemophilus, Aspergillus fumigatus, and nontuberculous mycobacteria.[5]

Bronchiectasis is a final common pathway for many diseases with diverse fundamental causes. Knowledge of the root cause of bronchiectasis in a particular patient is more helpful for treatment than an understanding of the generic subject of bronchiectasis. Bronchiectasis is associated with a wide range of disorders, but it usually results from necrotizing bacterial infections, such as infections caused by the Staphylococcus or Klebsiella species or Bordetella pertussis. Unfortunately, in about half the cases, the specific cause of bronchiectasis remains undetermined.[6]

Hemoptysis is common and may occur in as many as 50% of patients. Episodic hemoptysis with little to no sputum production (dry bronchiectasis) is usually a sequela of tuberculosis. However, massive hemoptysis may occur; bleeding usually originates in dilated bronchial arteries, which contain blood at systemic (rather than pulmonary) pressures.

Preferred examination

Diagnosis of bronchiectasis is based on a clinical history of daily viscid sputum production and characteristic computed tomography (CT) scan findings.[1, 4] (See the images below.)

Chest radiography is usually the first imaging examination, but the findings are often nonspecific, and the images can appear normal.[7] High-resolution computed tomography (HRCT) scanning was once the imaging modality of choice for assessing the possibility of bronchiectasis and its extent (see the images below). HRCT scanning also helped radiologists evaluate the surrounding tissue for other pathology, such as malignancy.[8]  

Until the advent of HRCT scanning, bronchography was the classic modality used for imaging bronchiectasis. Bronchography is performed by instilling an iodine-based contrast material via a catheter or bronchoscope, but it is rarely, if ever, performed today, as CT scanning has replaced it as the diagnostic modality of choice. HRCT scanning is noninvasive and has a sensitivity of 96% and a specificity of 93%.[9]  

Volumetric multidetector CT acquisition of the chest is now the preferred examination for the diagnosis of bronchiectasis. Compared with the previous criterion standard of high-resolution CT (HRCT), volumetric CT offers several improvements.[10, 11] Equivalent reconstructed HRCT images can be generated from the volumetric data set without additional scanning.[12] In addition, volumetric CT allows multiplanar reconstructions, which improve assurance of diagnosis, at least partially by permitting better assessment of absence of tapering of bronchi.[13, 14] By including the entire lung volume, volumetric CT increases the sensitivity of detection for smaller regions of bronchiectasis and permits more confident exclusion of the diagnosis.[10, 11, 14, 15] Pulmonary vessels and foci of mucous plugging can be differentiated from lung nodules with volumetric chest CT, avoiding unnecessary repeat examinations.[11, 14]

Volumetric CT can be acquired in a single breath-hold. This reduces breathing artifact, which can be confused with bronchiectasis.[10, 16] Since the initial demonstration of improvement in diagnostic accuracy with multidetector row CT, CT technology has progressed remarkably with the addition of more detectors and substantial improvements in scanner speed. These improvements have solidified the superiority of volumetric CT as the preferred examination.

Although volumetric CT has numerous advantages, the radiation dose is higher. Radiation dose can be mitigated by several techniques.[17] This is particularly important in pediatric patients, because of their increased radiation sensitivity. Radiologists should use modified protocols especially suited for children.[17, 18] Limited HRCT imaging could be appropriate in some patients for follow-up imaging in order to reduce the radiation dose.

The premise of a preferred examination for bronchiectasis implies that the requesting physician already knows the diagnosis, but bronchiectasis is only definitively diagnosed on chest CT. Bronchiectasis could be the suspected diagnosis triggering the request. However, as a practical matter, physicians request examinations in response to patient presentations, relying on the radiologist to protocol the examination to differentiate among possible conditions that could present similarly.[19, 20, 21, 22, 23] Most chest CT protocols are likely to demonstrate the findings of bronchiectasis, if present. Moreover, unsuspected bronchiectasis is often diagnosed on chest CT obtained for unrelated reasons. Once bronchiectasis is diagnosed, follow-up chest CT can be tailored for optimal assessment and follow-up of bronchiectasis, along with any other conditions.



View Image

The HRCT scan shows thick-walled, slightly ectatic bronchi. The patient has cystic fibrosis, which was diagnosed and treated since childhood.



View Image

This HRCT scan through the right upper lobe demonstrates bronchiectasis. Despite conventional antibiotic treatment, the patient continued to be sympto....



View Image

HRCT scan in a 75-year-old man with cystic bronchiectasis, right worse than left lower lobes.



View Image

This HRCT scan in a 13-year-old female shows left lower lobe bronchiectasis, secondary to tuberculosis.



View Image

This HRCT scan demonstrates findings of fluid-filled dilated bronchi in the left lower lobe of a 65-year-old man.

 

Clinical details

The classic clinical presentation for a patient with bronchiectasis is intermittent or daily, often purulent, sputum production. This is often accompanied by other symptoms such as dyspnea, fatigue, weight loss, chest pain, hemoptysis, and clubbing of the fingers.[24, 25, 26, 27, 28] Patients may develop respiratory failure or right heart failure.[24] The classic clinical presentation should prompt further investigation by chest CT.

However, bronchiectasis is a morphologic pattern, which is typically identified by chest CT. It is the final common pathway for many fundamental causes, which have a broad range of presentations. A more specific approach is to identify the basic cause of bronchiectasis, if possible, and consider the clinical details of that cause.

Pathophysiology

Bronchiectasis is not caused by a single factor, but is a complex interplay between repeated inflammation and a defective immune response to inflammation.[29] Many congenital or acquired abnormalities can prevent normal airway defense and repair, resulting in infection. If the initial reaction to infection is ineffective, the immune response is increased and prolonged, potentially causing a vicious circle of bronchial injury and increased inflammation that leads to bronchiectasis.[30] Bronchial damage includes variable amounts of bronchomalacia or fibrosis and disturbance of mucociliary function.

Examples of defective cellular or humoral immunity that predispose to bronchiectasis occur all along the immune response pathway. King et al found that adult patients with bronchiectasis had significantly lower levels of immunoglobulin G3 (IgG3), B-cell lymphocytes, and T-helper lymphocytes.[31] In about one third of adult bronchiectasis patients, King et al also found a significantly diminished neutrophil oxidative burst.[31] Numerous examples of diminished immunity have been cited to account for susceptibility to bronchiectasis, including primary immune deficiencies, positive HIV status, female sex, rheumatoid arthritis, and ulcerative colitis.[6, 32, 33, 34, 35]

Allergic bronchopulmonary aspergillosis is caused by an abnormal immune response to Aspergillus fumigatus, which results in bronchiectasis.[36] Infection can be the inciting cause for bronchiectasis. Viral infections associated with bronchiectasis include pertussis, measles, whooping cough, and influenza.[37, 38] Bacterial infections, such as Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, and typical and atypical tuberculosis, have been cultured from patients with bronchiectasis.[29, 37, 38, 39]

Ordinarily, pathogens are trapped by bronchial mucus and removed by the mucociliary elevator. Some patients, such as patients with cystic fibrosis or Young syndrome, have an altered mucous viscosity that impedes effective mucous removal.[40, 41] Others, such as patients with primary ciliary dyskinesia, have a defective anatomic mechanism for mucous clearance.[42, 43]

Altered anatomy can play a role in recurrent infections. A congenital abnormality that affects normal anatomy, such as communicating bronchopulmonary foregut malformation, tracheal bronchus, or accessory cardiac bronchus can precipitate bronchiectasis.[44] Patients with Williams-Campbell syndrome have a congenital cartilage defect that predisposes them to bronchiectasis,[45] while patients with Mounier-Kuhn syndrome (tracheobronchomegaly) have deficient tracheobronchial smooth muscle and elastic fibers.[46]

Inhalational lung injury from smoke or other noxious gases often is the initial event in the cycle ending in bronchiectasis.[47] Central bronchial obstruction can be caused by foreign body, broncholith, tumor, or lymphadenopathy, leading to bronchiectasis.[48, 49, 50] Patients with end-stage fibrosis can develop traction bronchiectasis and bronchiolectasis. Common examples include usual interstitial pneumonitis, tuberculosis, sarcoidosis, and radiation fibrosis. High negative pleural pressures and increased elastic recoil in pulmonary fibrosis interact to enlarge the bronchi.[51] The dilated bronchi are typically distorted with a beaded appearance.[52] Depending on the distribution of fibrosis, traction bronchiectasis can be regional or widespread. Traction bronchiectasis is restricted to the areas of end-stage fibrosis and particularly affects peripheral bronchi, which lack cartilage support.[51]

Epidemiology

A review of nontuberculous mycobacteria-associated hospitalizations showed a significant upward trend with increasing age for males and females.[53]  In adults, the prevalence of bronchiectasis trends upward with increasing age.[54, 55] The prevalence of bronchiectasis in patients aged 65 years and older has increased over time, possibly related to improved diagnosis and/or access to care.[56]  Weykert et al used a retrospective cohort design to estimate the prevalence of bronchiectasis in US adults.[54] They found a prevalence of bronchiectasis ranging from 4.2 cases per 100,000 persons (18-34 yr) to 271.8 cases per 100,000 persons (75 yr and older).[54]

Contrary to the case in the Western world, bronchiectasis is regarded as common in the East, though prevalence statistics are sparse.[57] Although the prevalence of pediatric bronchiectasis has generally been declining in the more developed world, numerous regional studies suggest that pediatric bronchiectasis remains a significant problem in the developing world.[58] Chang et al found a particularly high prevalence of bronchiectasis in aboriginal children aged 15 years and younger in Central Australia of 14.7 cases per 1,000 persons.[59] In a health screening program for adults in Seoul, Korea, the prevalence of bronchiectasis was 9.1%.[60]

For whites, cystic fibrosis is the most common life-threatening recessive genetic problem.[61] Cystic fibrosis occurs in about 1 in 3,200 white live births; 1 in 15,000 African-American live births; and 1 in 31,000 Asian-American live births.[61] In a University of Chicago study of 106 bronchiectasis patients of a diverse US population, bronchiectasis attributable to rheumatoid arthritis occurred more frequently in African-Americans than European-Americans, while bronchiectasis related to hematologic malignancy occurred more frequently in European-Americans than in African-Americans.[62] Hispanic-Americans had positive sputum culture for P aeruginosa more often than the other ethnic groups in that study.[62] A review of bronchiectasis in Medicare beneficiaries determined that for patients who had one chest CT scan, Asians were 2.5 times more likely to have bronchiectasis than whites and 3.9 times more likely than blacks.[56] A study of nontuberculous bronchiectasis in Medicare beneficiaries found the prevalence in blacks was half that of whites and the prevalence in Asians/Pacific Islanders was twice that of whites.[63]

Overall, bronchiectasis unrelated to cystic fibrosis occurs more frequently and is more severe in women.[35] Although cystic fibrosis has an equal distribution between males and females, the diagnosis may be delayed in females, which could explain why females tend to die younger.[64]  Rheumatoid arthritis,[65] sarcoidosis,[66] and Sjögren syndrome all have a female predominance and predispose to bronchiectasis. Mycobacterial tuberculosis occurs more frequently in males.[67, 68]  Mycobacterium avium complex has generally been found more frequently in older women.[63, 69, 70, 71] Women in the United States are diagnosed with nontuberculous mycobacterial disease 1.4 times more frequently than men among Medicare patients older than 65 years.[63] With various study methodologies and geographic locations, sex ratios for nontuberculous mycobacterial disease can vary considerably.[72]

Mortality/morbidity

Pediatric bronchiectasis in the developing world carries a higher rate of morbidity and mortality, at least partially related to poorer nutrition.[58] Hemoptysis and chronic respiratory failure are also more common in the developing world.[58]

Quality of life can be assessed by the St George’s Respiratory Questionnaire or the Leicester Cough Questionnaire.[73] Frequency of exacerbations of symptoms can be used to judge effectiveness of treatment, and exercise capacity can be evaluated by the incremental shuffle walk test or the 6-minute walking test.[73]

Mortality risk is correlated with numerous demographic, pulmonary function, and quality-of-life variables.[74] CT imaging variables with the highest mortality risk include extent of bronchiectasis, severity of dilatation, and bronchial wall thickness.[74] Surgical mortality for bronchiectasis ranges from 0-2.2% and morbidity is 18-23%.[75]

Patients with cystic bronchiectasis are at risk for developing a mycetoma within a dilated bronchus. Hemoptysis is common and may occur in as many as 50% of patients. Episodic hemoptysis with little to no sputum production (dry bronchiectasis) is usually a sequela of tuberculosis. However, massive hemoptysis may occur; bleeding usually originates in dilated bronchial arteries, which contain blood at systemic (rather than pulmonary) pressures.[76]

Anatomy

The main anatomic types of bronchiectasis are the following[8] :

Key anatomic pearls

Differentials

Alpha1-Antitrypsin Deficiency

Aspiration Pneumonia

Asthma

Bacterial Pneumonia

Bronchitis

Chronic Obstructive Pulmonary Disease

Emphysema

Eosinophilic Granuloma (Histiocytosis X)

Lymphangioleiomyomatosis

Recurrent Respiratory Papillomatosis

Tuberculosis

Limitations of techniques

In general, if a volumetric study of the chest is obtained without significant motion artifact in an adult patient, there should be no important limitation to the identification or exclusion of bronchiectasis. However, the operational definition of bronchiectasis is "irreversible, abnormal dilatation of the bronchi."[7, 8] Reversible bronchial dilatation has been identified rarely in adults.[80] Gaillard et al reviewed follow-up CT examinations in 22 non–cystic fibrosis pediatric patients with bronchial dilatation. In 6 patients, the bronchial dilatation resolved completely and in 8 patients there was improvement.[81] For patients with complete reversal of bronchial dilatation, a single study would be insufficient.

Bronchoscopy is not helpful in diagnosing bronchiectasis, but it may be used to identify underlying abnormalities, such as tumors and foreign bodies.

Chest radiographs may be negative in patients with minor to moderate disease. Many abnormal radiographic findings may be nonspecific, and confirmation using volumetric CT scanning may be required.

Bronchography is rarely indicated because it is invasive and is associated with allergic reactions to the contrast material. Bronchography also carries the risk of acute bronchoconstriction.

Radiography

Chest radiography helps to identify serious disease, and it was once the standard imaging modality.[2] However, the radiographs may depict no abnormalities, or the findings may be nonspecific in patients with less-severe disease.[3]

Various abnormal radiographic findings have been described as follows (see the images below)[82, 83, 84] :

Additional nonspecific radiographic findings in bronchiectasis include the following:

Traction bronchiectasis occurs with pulmonary fibrosis. In pulmonary fibrosis, honeycombing and distortion can be visible radiographically. However, the radiographic diagnosis of traction bronchiectasis can be difficult, unless the surrounding lung is opacified.[83] Patients with bronchiectasis are at increased risk for pneumonia. Chest radiography can be used for detection and follow-up of pneumonia associated with bronchiectasis.

Bronchography

Bronchography was the investigation of choice for bronchiectasis from its introduction in 1922 until the advent of HRCT scanning in the mid-1980s. Currently, bronchography is rarely used. Bronchography is performed by instilling contrast material via a catheter or bronchoscope under fluoroscopic control and conventional radiographic imaging. The procedure is unpleasant for the patient and is also associated with temporary impairment of ventilation, as well as allergic and foreign body reactions to the contrast medium. In addition, interpretation of bronchographic images is difficult, owing to underfilling and retained secretions.

Degree of confidence

The accuracy of conventional radiographic findings in the diagnosis of bronchiectasis is unknown, because the findings are variable and nonspecific and depend on the severity and extent of the bronchiectasis. However, the severity of disease as seen on conventional radiography and HRCT scans shows good correlation. Chest radiographic findings may be normal or nonspecific in patients with less severe disease. The prevalence of signs of bronchiectasis at radiography correlates with the severity of bronchiectasis at HRCT, although radiography is less sensitive and less specific.[85]

False positives/negatives

Many conventional radiographic findings are nonspecific and can be seen in patients with idiopathic pulmonary fibrosis, sarcoidosis, histiocytosis X, rheumatoid lung, and other chronic interstitial lung disorders.

If bronchiectasis is detected radiographically, chest CT is appropriate for categorization of extent and morphologic severity.

Computed Tomography

CT is the primary imaging modality for bronchiectasis.[1, 4, 10, 11, 13, 14, 52, 81, 86, 87, 88, 89]

CT indications of bronchiectasis include the following[7, 79, 90, 91, 92] :

The following are commonly associated with bronchiectasis:



View Image

HRCT scan in a 75-year-old man with cystic bronchiectasis, right worse than left lower lobes.

 On axial images, in cylindrical bronchiectasis, bronchi coursing horizontally are seen as parallel lines, and vertically oriented bronchi are seen as circular lucencies that are larger than the adjacent pulmonary artery (signet-ring appearance). (See the image below.)



View Image

This HRCT scan in a 13-year-old female shows left lower lobe bronchiectasis, secondary to tuberculosis.

Varicose bronchiectasis may be seen as nonuniform bronchial dilatation. Other findings include:

Fluid-filled bronchi present as tubular or branching structures when they course horizontally or nodules when they are perpendicular to the plane of the CT scan section (see the image below).



View Image

This HRCT scan demonstrates findings of fluid-filled dilated bronchi in the left lower lobe of a 65-year-old man.

 

Degree of confidence

Except for extremely obese patients and examinations compromised by motion, volumetric imaging of the chest provides a very high degree of confidence to confirm or deny the diagnosis of bronchiectasis. HRCT scanning has a sensitivity of 96% and a specificity of 93%,[9] as compared with bronchography.

Some patients without bronchiectasis have a 1.49:1 bronchus-to-artery ratio; therefore, the ratio is reliable only if it is greater than 1.5. If the ratio is less than 1.5, other signs, such as bronchial wall thickening and lack of tapering, should be present for the diagnosis of bronchiectasis.

Bronchial measurements may vary with the use of different window levels and window widths.[39]   Bronchial wall thickening is optimally seen with wide window width, such as 1000, and a low window level, such as -700 HU.  Aritfactual wall thickening can be produced by changing window width.[40] A bronchial wall thickening finding is not specific and is also seen in patients with asthma and smokers. Bronchiectasis occurs frequently in smokers with chronic obstructive pulmonary disease (COPD). In a quantitative CT study of patients with bronchiectasis who smoked, the BA ratio (bronchial lumen and adjacent artery), wall thickness, and wall area percent were significantly greater for whole lung and 4th-6th airway generations.[89]

False positives/negatives

The variability of the bronchus-to-artery ratio at high altitudes and in patients with pulmonary hypertension may result in an overdiagnosis because of vasoconstriction in these conditions. The bronchial diameter relative to the adjacent pulmonary artery also increases with increasing altitude.[94]

In patients with consolidation, dilated bronchi may not be seen. Cardiac and respiratory artifacts may obscure the results or mimic subtle bronchiectasis in the left lower lobe. Rarely, histiocytosis X and cavitating pulmonary masses mimic cystic bronchiectasis. Traction bronchiectasis occurs in patients with interstitial fibrosis and results from fibrous tethering of the bronchial wall. Rather than a primary bronchial abnormality, the bronchiectasis is caused by tethering and traction.

The patient’s age should be considered, since the bronchoarterial ratio increases with age.[86] In rare instances in adults, but more frequently in pediatric patients, bronchiectasis can be reversible.

A dilated, cystic bronchus should be distinguished from a bulla, since a bronchial cyst has a perceptible wall, while a bulla does not.

At times, severely dilated bronchi with associated volume loss can simulate honeycombing.[90]

Magnetic Resonance Imaging

MRI can be used to find bronchial wall thickening and dilatation of central bronchi, but spatial resolution limits assessment of smaller airways, such as third to fourth generation.[95] Different sequences, including fast breath–hold acquisition techniques and very short echo-time, are increasingly used for better pulmonary detail.[96, 97]

While  volumetric CT remains the primary mode of assessment for bronchiectasis in adults, for cystic fibrosis patients and for young patients who may need repeated follow-up examinations, MRI yields useful information.

Teufel et al compared HRCT and 1.5-Tesla MRI using a very short echo time in 51 patients with cystic fibrosis. For these patients, both CT and MRI were able to detect bronchiectasis, mucous plugging, and peribronchial thickening, with MRI strongly correlating with the CT findings.[87] Montella et al compared chest MRI with HRCT in 50 non–cystic fibrosis pediatric patients, and both modalities demonstrated bronchiectasis in approximately 72% of those subjects. Other findings in chronic pediatric lung disease were also assessed, with results supporting the use of chest MRI as a reasonable alternative to CT.[98]

Although CT has better spatial resolution and shows morphology in more detail than MRI, MRI is superior for assessment of functional changes of altered hemodynamics and perfusion.[95] ][9] Helium-3 (3He) MRI may be used for evaluation of pulmonary ventilation and function.[99]

Nuclear Imaging

Patients with bronchiectasis can suffer from chronic productive cough, recurrent infections, and hemoptysis. V/Q scanning can be useful in determining whether surgical resection is appropriate therapy, especially for hemoptysis. In one series, 23 of 66 patients treated surgically had hemoptysis as a symptom. V/Q scanning demonstrated undiminished perfusion in cylindrical bronchiectasis, but areas of cystic or mixed cystic and cylindrical bronchiectasis showed perfusion defects. If a patient has a scan showing less than 10% perfusion of a bronchiectatic region, those patients can benefit from surgical resection of that nonfunctional region.[100]

The purpose of a V/Q scan is to determine perfused versus nonperfused areas of lung rather than to make a diagnosis of bronchiectasis. Different diseases can cause nonperfused areas of lung, so V/Q is used in conjunction with CT or MRI.

Angiography

Hemoptysis is symptomatic of a potentially life-threatening condition and warrants urgent and comprehensive evaluation of the lung parenchyma, airways, and thoracic vasculature.

Multidetector-row CT angiography permits noninvasive, rapid, and accurate assessment of the cause and consequences of hemorrhage into the airways and helps guide subsequent management.[21, 101] The combined use of thin-section axial scans and more complex reformatted images allows clear depiction of the origins and trajectories of abnormally dilated systemic arteries that may be the source of hemorrhage and that may require embolization.

The vasculature, pulmonary parenchyma, and airways can be assessed with Multidetector CT angiography. In disorders with chronic lung inflammation, including bronchiectasis, abnormal collateral systemic vessels form in the affected parts of the lung. These collateral bronchial arteries appear as tortuous vessels and can bleed. Occasionally, nonbronchial systemic arteries or pulmonary arteries bleed. Multiplanar reformatted images are used for identifying the origins and courses of these vessels.

Bronchiectasis, chronic bronchitis, lung malignancy, tuberculosis, and chronic fungal infection are some of the most common underlying causes of hemoptysis and are easily detected with CT angiography.

Results from multidetector CT angiography can be used to direct therapeutic angiography for bronchial or pulmonary arterial embolization or surgical resection.

Occasionally, an examination is limited by artifact from patient motion, data depletion from a very large patient, or timing of contrast bolus. Otherwise, multidetector row CT usually demonstrates the vasculature and the pulmonary parenchyma well.

In a series of 22 patients, using 16-detector row CT, bronchial (100%) and nonbronchial (62%) arteries causing hemoptysis were visible, with most traceable throughout their length.[102] Substantial technological advances in CT since then allow more detailed visualization.

Author

Brenda L Holbert, MD, FACR, Radiologist, Department of Radiology, Wake Forest University School of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

John M Holbert, MD, Professor of Radiology, Wake Forest University School of Medicine

Disclosure: Received royalty from Amirsys for independent contractor.

Chief Editor

Eugene C Lin, MD, Attending Radiologist, Teaching Coordinator for Cardiac Imaging, Radiology Residency Program, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Judith K Amorosa, MD, FACR, Clinical Professor of Radiology and Vice Chair for Faculty Development and Medical Education, Rutgers Robert Wood Johnson Medical School

Disclosure: Nothing to disclose.

Acknowledgements

Isaac Hassan, MB, ChB, FRCR, DMRD Former Senior Consultant Radiologist, Department of Radiology, St Bernard's Hospital

Isaac Hassan, MB, ChB, FRCR, DMRD is a member of the following medical societies: American Roentgen Ray Society and Royal College of Radiologists

Disclosure: Nothing to disclose.

References

  1. Milliron B, Henry TS, Veeraraghavan S, Little BP. Bronchiectasis: Mechanisms and Imaging Clues of Associated Common and Uncommon Diseases. Radiographics. 2015 Jul-Aug. 35 (4):1011-30. [View Abstract]
  2. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008 Mar. 246(3):697-722. [View Abstract]
  3. Hogg JC, Macklem PT, Thurlbeck WM. Site and nature of airway obstruction in chronic obstructive lung disease. N Engl J Med. 1968 Jun 20. 278(25):1355-60. [View Abstract]
  4. Dodd JD, Lavelle LP, Fabre A, Brady D. Imaging in cystic fibrosis and non-cystic fibrosis bronchiectasis. Semin Respir Crit Care Med. 2015 Apr. 36 (2):194-206. [View Abstract]
  5. Boyton RJ, Altmann DM. Bronchiectasis: Current Concepts in Pathogenesis, Immunology, and Microbiology. Annu Rev Pathol. 2016 May 23. 11:523-54. [View Abstract]
  6. Boyton RJ. Bronchiectasis. Medicine. Respiratory Disorders. May 2012. 40:5:267-272.
  7. Kang EY, Miller RR, Müller NL. Bronchiectasis: comparison of preoperative thin-section CT and pathologic findings in resected specimens. Radiology. 1995 Jun. 195(3):649-54. [View Abstract]
  8. REID LM. Reduction in bronchial subdivision in bronchiectasis. Thorax. 1950 Sep. 5(3):233-47. [View Abstract]
  9. Westcott JL, Cole SR. Traction bronchiectasis in end-stage pulmonary fibrosis. Radiology. 1986 Dec. 161(3):665-9. [View Abstract]
  10. Hill LE, Ritchie G, Wightman AJ, Hill AT, Murchison JT. Comparison between conventional interrupted high-resolution CT and volume multidetector CT acquisition in the assessment of bronchiectasis. Br J Radiol. 2010 Jan. 83(985):67-70. [View Abstract]
  11. Dodd JD, Souza CA, Muller NL. Conventional high-resolution CT versus helical high-resolution MDCT in the detection of bronchiectasis. AJR Am J Roentgenol. 2006 Aug. 187(2):414-20. [View Abstract]
  12. Studler U, Gluecker T, Bongartz G, Roth J, Steinbrich W. Image quality from high-resolution CT of the lung: comparison of axial scans and of sections reconstructed from volumetric data acquired using MDCT. AJR Am J Roentgenol. 2005 Sep. 185(3):602-7. [View Abstract]
  13. Chooi WK, Matthews S, Bull MJ, Morcos SK. Multislice helical CT: the value of multiplanar image reconstruction in assessment of the bronchi and small airways disease. Br J Radiol. 2003 Aug. 76(908):536-40. [View Abstract]
  14. Sung YM, Lee KS, Yi CA, Yoon YC, Kim TS, Kim S. Additional coronal images using low-milliamperage multidetector-row computed tomography: effectiveness in the diagnosis of bronchiectasis. J Comput Assist Tomogr. 2003 Jul-Aug. 27(4):490-5. [View Abstract]
  15. Remy-Jardin M, Amara A, Campistron P, et al. Diagnosis of bronchiectasis with multislice spiral CT: accuracy of 3-mm-thick structured sections. Eur Radiol. 2003 May. 13(5):1165-71. [View Abstract]
  16. Tarver RD, Conces DJ Jr, Godwin JD. Motion artifacts on CT simulate bronchiectasis. AJR Am J Roentgenol. 1988 Dec. 151(6):1117-9. [View Abstract]
  17. McCollough CH, Primak AN, Braun N, Kofler J, Yu L, Christner J. Strategies for reducing radiation dose in CT. Radiol Clin North Am. 2009 Jan. 47(1):27-40. [View Abstract]
  18. Loeve M, Lequin MH, de Bruijne M, et al. Cystic fibrosis: are volumetric ultra-low-dose expiratory CT scans sufficient for monitoring related lung disease?. Radiology. 2009 Oct. 253(1):223-9. [View Abstract]
  19. Dyer DS, Khan AR, Mohammed TL, et al. ACR Appropriateness Criteria on chronic dyspnea: suspected pulmonary origin. J Thorac Imaging. 2010 May. 25(2):W21-3. [View Abstract]
  20. Heitkamp DE, Mohammed TL, Kirsch J, et al. ACR appropriateness criteria(®)acute respiratory illness in immunocompromised patients. J Am Coll Radiol. 2012 Mar. 9(3):164-9. [View Abstract]
  21. Jeudy J, Khan AR, Mohammed TL, et al. ACR Appropriateness Criteria hemoptysis. J Thorac Imaging. 2010 Aug. 25(3):W67-9. [View Abstract]
  22. Kirsch J, Ramirez J, Mohammed TL, et al. ACR Appropriateness Criteria® acute respiratory illness in immunocompetent patients. J Thorac Imaging. 2011 May. 26(2):W42-4. [View Abstract]
  23. American College of Radiology. ACR Appropriateness Criteria®: pulmonary hypertension. Available at http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/PulmonaryHypertension.pdf. Accessed: 20 April, 2013.
  24. Pasteur MC, Bilton D, Hill AT. British Thoracic Society guideline for non-CF bronchiectasis. Thorax. 2010 Jul. 65 Suppl 1:i1-58. [View Abstract]
  25. Feldman C. Bronchiectasis: new approaches to diagnosis and management. Clin Chest Med. 2011 Sep. 32(3):535-46. [View Abstract]
  26. Redding GJ. Bronchiectasis in children. Pediatr Clin North Am. 2009 Feb. 56(1):157-71, xi. [View Abstract]
  27. Griffith DE, Aksamit TR. Bronchiectasis and nontuberculous mycobacterial disease. Clin Chest Med. 2012 Jun. 33(2):283-95. [View Abstract]
  28. Pappalettera M, Aliberti S, Castellotti P, Ruvolo L, Giunta V, Blasi F. Bronchiectasis: an update. Clin Respir J. 2009 Jul. 3(3):126-34. [View Abstract]
  29. Moulton BC, Barker AF. Pathogenesis of bronchiectasis. Clin Chest Med. 2012 Jun. 33(2):211-7. [View Abstract]
  30. Cole PJ. Inflammation: a two-edged sword--the model of bronchiectasis. Eur J Respir Dis Suppl. 1986. 147:6-15. [View Abstract]
  31. King PT, Hutchinson P, Holmes PW, et al. Assessing immune function in adult bronchiectasis. Clin Exp Immunol. 2006 Jun. 144(3):440-6. [View Abstract]
  32. Notarangelo LD, Plebani A, Mazzolari E, Soresina A, Bondioni MP. Genetic causes of bronchiectasis: primary immune deficiencies and the lung. Respiration. 2007. 74(3):264-75. [View Abstract]
  33. McGuinness G, Naidich DP, Garay S, Leitman BS, McCauley DI. AIDS associated bronchiectasis: CT features. J Comput Assist Tomogr. 1993 Mar-Apr. 17(2):260-6. [View Abstract]
  34. Holmes AH, Pelton S, Steinbach S, Luzzi GA. HIV related bronchiectasis. Thorax. 1995 Nov. 50(11):1227. [View Abstract]
  35. Morrissey BM, Harper RW. Bronchiectasis: sex and gender considerations. Clin Chest Med. 2004 Jun. 25(2):361-72. [View Abstract]
  36. Greenberger PA. Chapter 18: Allergic bronchopulmonary aspergillosis. Allergy Asthma Proc. 2012 May-Jun. 33 Suppl 1:S61-3. [View Abstract]
  37. Pasteur MC, Helliwell SM, Houghton SJ, et al. An investigation into causative factors in patients with bronchiectasis. Am J Respir Crit Care Med. 2000 Oct. 162(4 Pt 1):1277-84. [View Abstract]
  38. Coleman LT, Kramer SS, Markowitz RI, Kravitz RM. Bronchiectasis in children. J Thorac Imaging. 1995 Winter. 10(4):268-79. [View Abstract]
  39. Eastham KM, Fall AJ, Mitchell L, Spencer DA. The need to redefine non-cystic fibrosis bronchiectasis in childhood. Thorax. 2004 Apr. 59(4):324-7. [View Abstract]
  40. Goeminne PC, Dupont LJ. The sinusitis-infertility syndrome: Young's saint, old devil. Eur Respir J. 2010 Mar. 35(3):698. [View Abstract]
  41. Southern KW. Cystic fibrosis and formes frustes of CFTR-related disease. Respiration. 2007. 74(3):241-51. [View Abstract]
  42. Morillas HN, Zariwala M, Knowles MR. Genetic causes of bronchiectasis: primary ciliary dyskinesia. Respiration. 2007. 74(3):252-63. [View Abstract]
  43. Sagel SD, Davis SD, Campisi P, Dell SD. Update of respiratory tract disease in children with primary ciliary dyskinesia. Proc Am Thorac Soc. 2011 Sep. 8(5):438-43. [View Abstract]
  44. Desir A, Ghaye B. Congenital abnormalities of intrathoracic airways. Radiol Clin North Am. 2009 Mar. 47(2):203-25. [View Abstract]
  45. Williams HE, Landau LI, Phelan PD. Generalized bronchiectasis due to extensive deficiency of bronchial cartilage. Arch Dis Child. 1972 Jun. 47(253):423-8. [View Abstract]
  46. Woodring JH, Howard RS 2nd, Rehm SR. Congenital tracheobronchomegaly (Mounier-Kuhn syndrome): a report of 10 cases and review of the literature. J Thorac Imaging. 1991 Apr. 6(2):1-10. [View Abstract]
  47. Palmieri TL. Long term outcomes after inhalation injury. J Burn Care Res. 2009 Jan-Feb. 30(1):201-3. [View Abstract]
  48. Kurklu EU, Williams MA, Le Roux BT. Bronchiectasis consequent upon foreign body retention. Thorax. 1973 Sep. 28(5):601-2. [View Abstract]
  49. Seo JB, Song KS, Lee JS, et al. Broncholithiasis: review of the causes with radiologic-pathologic correlation. Radiographics. 2002 Oct. 22 Spec No:S199-213. [View Abstract]
  50. Cantin L, Bankier AA, Eisenberg RL. Bronchiectasis. AJR Am J Roentgenol. 2009 Sep. 193(3):W158-71. [View Abstract]
  51. Westcott JL, Cole SR. Traction bronchiectasis in end-stage pulmonary fibrosis. Radiology. 1986 Dec. 161(3):665-9. [View Abstract]
  52. Naidich David P, Monvadi B Srichai. Computed Tomography and Magnetic Resonance of the Thorax. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2007.
  53. Billinger ME, Olivier KN, Viboud C, et al. Nontuberculous mycobacteria-associated lung disease in hospitalized persons, United States, 1998-2005. Emerg Infect Dis. 2009 Oct. 15(10):1562-9. [View Abstract]
  54. Weycker D, Edelsberg J, Oster G, Tino G. Prevalence andeconomic burden of bronchiectasis. Clin Pulm Med. 2005. 12:205–9.
  55. Seitz AE, Olivier KN, Steiner CA, Montes de Oca R, Holland SM, Prevots DR. Trends and burden of bronchiectasis-associated hospitalizations in the United States, 1993-2006. Chest. 2010 Oct. 138(4):944-9. [View Abstract]
  56. Seitz AE, Olivier KN, Adjemian J, Holland SM, Prevots R. Trends in bronchiectasis among medicare beneficiaries in the United States, 2000 to 2007. Chest. 2012 Aug. 142(2):432-9. [View Abstract]
  57. Tsang KW, Tipoe GL. Bronchiectasis: not an orphan disease in the East. Int J Tuberc Lung Dis. 2004 Jun. 8(6):691-702. [View Abstract]
  58. Kapur N, Karadag B. Differences and similarities in non-cystic fibrosis bronchiectasis between developing and affluent countries. Paediatr Respir Rev. 2011 Jun. 12(2):91-6. [View Abstract]
  59. Chang AB, Masel JP, Boyce NC, Wheaton G, Torzillo PJ. Non-CF bronchiectasis: clinical and HRCT evaluation. Pediatr Pulmonol. 2003 Jun. 35(6):477-83. [View Abstract]
  60. Kwak HJ, Moon JY, Choi YW, et al. High prevalence of bronchiectasis in adults: analysis of CT findings in a health screening program. Tohoku J Exp Med. 2010 Dec. 222(4):237-42. [View Abstract]
  61. Hamosh A, FitzSimmons SC, Macek M Jr, Knowles MR, Rosenstein BJ, Cutting GR. Comparison of the clinical manifestations of cystic fibrosis in black and white patients. J Pediatr. 1998 Feb. 132(2):255-9. [View Abstract]
  62. McShane PJ, Naureckas ET, Strek ME. Bronchiectasis in a diverse US population: effects of ethnicity on etiology and sputum culture. Chest. 2012 Jul. 142(1):159-67. [View Abstract]
  63. Adjemian J, Olivier KN, Seitz AE, Holland SM, Prevots DR. Prevalence of nontuberculous mycobacterial lung disease in U.S. Medicare beneficiaries. Am J Respir Crit Care Med. 2012 Apr 15. 185(8):881-6. [View Abstract]
  64. Lai HC, Kosorok MR, Laxova A, Makholm LM, Farrell PM. Delayed diagnosis of US females with cystic fibrosis. Am J Epidemiol. 2002 Jul 15. 156(2):165-73. [View Abstract]
  65. Symmons D, Turner G, Webb R, Asten P, Barrett E, Lunt M, et al. The prevalence of rheumatoid arthritis in the United Kingdom: new estimates for anew century. Rheumatology (Oxford). 2002 Jul. 41(7):793-800.
  66. Rybicki BA, Maliarik MJ, Major M, Popovich J Jr, Iannuzzi MC. Epidemiology, demographics, and genetics of sarcoidosis. Semin Respir Infect. 1998 Sep. 13(3):166-73. [View Abstract]
  67. Tam CM, Leung CC, Noertjojo K, Chan SL, Chan-Yeung M. Tuberculosis in Hong Kong-patient characteristics and treatment outcome. Hong Kong Med J. 2003 Apr. 9(2):83-90. [View Abstract]
  68. Perez-Guzman C, Vargas MH, Torres-Cruz A, Perez-Padilla JR, Furuya ME, Villarreal-Velarde H. Diabetes modifies the male:female ratio in pulmonary tuberculosis. Int J Tuberc Lung Dis. 2003 Apr. 7(4):354-8. [View Abstract]
  69. Kubo K, Yamazaki Y, Hachiya T, et al. Mycobacterium avium-intracellulare pulmonary infection in patients without known predisposing lung disease. Lung. 1998. 176(6):381-91. [View Abstract]
  70. Prince DS, Peterson DD, Steiner RM, et al. Infection with Mycobacterium avium complex in patients without predisposing conditions. N Engl J Med. 1989 Sep 28. 321(13):863-8. [View Abstract]
  71. Yamazaki Y, Kubo K, Fujimoto K, Matsuzawa Y, Sekiguchi M, Honda T. Pulmonary function tests of Mycobacterium avium-intracellulare infection: correlation with bronchoalveolar lavage fluid findings. Respiration. 2000. 67(1):46-51. [View Abstract]
  72. Marras TK, Mehta M, Chedore P, May K, Al Houqani M, Jamieson F. Nontuberculous mycobacterial lung infections in Ontario, Canada: clinical and microbiological characteristics. Lung. 2010 Aug. 188(4):289-99. [View Abstract]
  73. Smith MP, Hill AT. Evaluating success of therapy for bronchiectasis: what end points to use?. Clin Chest Med. 2012 Jun. 33(2):329-49. [View Abstract]
  74. Loebinger MR, Wells AU, Hansell DM, et al. Mortality in bronchiectasis: a long-term study assessing the factors influencing survival. Eur Respir J. 2009 Oct. 34(4):843-9. [View Abstract]
  75. Agasthian T. Results of surgery for bronchiectasis and pulmonary abscesses. Thorac Surg Clin. 2012 Aug. 22(3):333-44. [View Abstract]
  76. McDonnell MJ, Aliberti S, Goeminne PC, Restrepo MI, Finch S, Pesci A, et al. Comorbidities and the risk of mortality in patients with bronchiectasis: an international multicentre cohort study. Lancet Respir Med. 2016 Dec. 4 (12):969-979. [View Abstract]
  77. Cartier Y, Kavanagh PV, Johkoh T, Mason AC, Muller NL. Bronchiectasis: accuracy of high-resolution CT in the differentiation of specific diseases. AJR Am J Roentgenol. 1999 Jul. 173(1):47-52. [View Abstract]
  78. Menon B, Aggarwal B, Iqbal A. Mounier-Kuhn syndrome: report of 8 cases of tracheobronchomegaly with associated complications. South Med J. 2008 Jan. 101(1):83-7. [View Abstract]
  79. Javidan-Nejad C, Bhalla S. Bronchiectasis. Radiol Clin North Am. 2009 Mar. 47(2):289-306. [View Abstract]
  80. Yap VL, Metersky ML. Reversible bronchiectasis in an adult: a case report. J Bronchology Interv Pulmonol. 2012 Oct. 19(4):336-7. [View Abstract]
  81. Gaillard EA, Carty H, Heaf D, Smyth RL. Reversible bronchial dilatation in children: comparison of serial high-resolution computer tomography scans of the lungs. Eur J Radiol. 2003 Sep. 47(3):215-20. [View Abstract]
  82. Woodring JH. Improved plain film criteria for the diagnosis of bronchiectasis. J Ky Med Assoc. 1994 Jan. 92(1):8-13. [View Abstract]
  83. Westcott JL. Bronchiectasis. Radiol Clin North Am. 1991 Sep. 29(5):1031-42. [View Abstract]
  84. Martinez S, Heyneman LE, McAdams HP, Rossi SE, Restrepo CS, Eraso A. Mucoid impactions: finger-in-glove sign and other CT and radiographic features. Radiographics. 2008 Sep-Oct. 28(5):1369-82. [View Abstract]
  85. van der Bruggen-Bogaarts BA, van der Bruggen HM, van Waes PF, Lammers JW. Screening for bronchiectasis. A comparative study between chest radiography and high-resolution CT. Chest. 1996 Mar. 109(3):608-11. [View Abstract]
  86. Matsuoka S, Uchiyama K, Shima H, Ueno N, Oish S, Nojiri Y. Bronchoarterial ratio and bronchial wall thickness on high-resolution CT in asymptomatic subjects: correlation with age and smoking. AJR Am J Roentgenol. 2003 Feb. 180(2):513-8. [View Abstract]
  87. Teufel M, Ketelsen D, Fleischer S, et al. Comparison between High-Resolution CT and MRI Using a Very Short Echo Time in Patients with Cystic Fibrosis with Extra Focus on Mosaic Attenuation. Respiration. 2012 Nov 27. [View Abstract]
  88. do Amaral RH, Nin CS, de Souza VV, Alves GR, Marchiori E, Irion K, et al. Computed Tomography Findings of Bronchiectasis in Different Respiratory Phases Correlate with Pulmonary Function Test Data in Adults. Lung. 2017 Mar 28. [View Abstract]
  89. Diaz AA, Young TP, Maselli DJ, Martinez CH, Gill R, Nardelli P, et al. Quantitative CT measures of bronchiectasis in smokers. Chest. 2016 Nov 24. [View Abstract]
  90. Bonavita J, Naidich DP. Imaging of bronchiectasis. Clin Chest Med. 2012 Jun. 33(2):233-48. [View Abstract]
  91. Ouellette H. The signet ring sign. Radiology. 1999 Jul. 212(1):67-8. [View Abstract]
  92. Cantin L, Bankier AA, Eisenberg RL. Bronchiectasis. AJR Am J Roentgenol. 2009 Sep. 193(3):W158-71. [View Abstract]
  93. Naidich DP, McCauley DI, Khouri NF, Stitik FP, Siegelman SS. Computed tomography of bronchiectasis. J Comput Assist Tomogr. 1982 Jun. 6(3):437-44. [View Abstract]
  94. Kim JS, Muller NL, Park CS, et al. Bronchoarterial ratio on thin section CT: comparison between high altitude and sea level. J Comput Assist Tomogr. 1997 Mar-Apr. 21(2):306-11. [View Abstract]
  95. Biederer J, Mirsadraee S, Beer M, et al. MRI of the lung (3/3)-current applications and future perspectives. Insights Imaging. 2012 Aug. 3(4):373-86. [View Abstract]
  96. Capaldi DP, Sheikh K, Guo F, Svenningsen S, Etemad-Rezai R, Coxson HO, et al. Free-breathing pulmonary 1H and Hyperpolarized 3He MRI: comparison in COPD and bronchiectasis. Acad Radiol. 2015 Mar. 22 (3):320-9. [View Abstract]
  97. Ma W, Sheikh K, Svenningsen S, Pike D, Guo F, Etemad-Rezai R, et al. Ultra-short echo-time pulmonary MRI: evaluation and reproducibility in COPD subjects with and without bronchiectasis. J Magn Reson Imaging. 2015 May. 41 (5):1465-74. [View Abstract]
  98. Montella S, Maglione M, Bruzzese D, et al. Magnetic resonance imaging is an accurate and reliable method to evaluate non-cystic fibrosis paediatric lung disease. Respirology. 2012 Jan. 17(1):87-91. [View Abstract]
  99. Washko GR, Parraga G, Coxson HO. Quantitative pulmonary imaging using computed tomography and magnetic resonance imaging. Respirology. 2012 Apr. 17(3):432-44. [View Abstract]
  100. Al-Kattan KM, Essa MA, Hajjar WM, Ashour MH, Saleh WN, Rafay MA. Surgical results for bronchiectasis based on hemodynamic (functional and morphologic) classification. J Thorac Cardiovasc Surg. 2005 Nov. 130(5):1385-90. [View Abstract]
  101. Bruzzi JF, Remy-Jardin M, Delhaye D, Teisseire A, Khalil C, Remy J. Multi-detector row CT of hemoptysis. Radiographics. 2006 Jan-Feb. 26(1):3-22. [View Abstract]
  102. Yoon YC, Lee KS, Jeong YJ, Shin SW, Chung MJ, Kwon OJ. Hemoptysis: bronchial and nonbronchial systemic arteries at 16-detector row CT. Radiology. 2005 Jan. 234(1):292-8. [View Abstract]

The HRCT scan shows thick-walled, slightly ectatic bronchi. The patient has cystic fibrosis, which was diagnosed and treated since childhood.

This HRCT scan through the right upper lobe demonstrates bronchiectasis. Despite conventional antibiotic treatment, the patient continued to be symptomatic. Eventually, she underwent bronchoscopy, and sampled cultures grew Mycobacterium avium-intracellulare complex.

HRCT scan in a 75-year-old man with cystic bronchiectasis, right worse than left lower lobes.

This HRCT scan in a 13-year-old female shows left lower lobe bronchiectasis, secondary to tuberculosis.

This HRCT scan demonstrates findings of fluid-filled dilated bronchi in the left lower lobe of a 65-year-old man.

A 27-year-old man diagnosed with reactive airway disease as a child was examined because of frequent respiratory infections. The posteroanterior chest radiograph shows ill-defined pulmonary nodular opacities, mild scoliosis, and moderate overaeration.

A close-up radiograph of the left upper lung in a 31-year-old woman with chronic cough since childhood shows nodules in the left upper lung; the right upper lung was similarly involved.

A 65-year-old woman was examined for chronic cough. The lateral chest radiograph shows hyperinflation and accentuation of the central bronchial interstitium.

This posteroanterior chest radiograph shows hyperinflation and partially obscured heart borders.

HRCT scan in a 75-year-old man with cystic bronchiectasis, right worse than left lower lobes.

This HRCT scan in a 13-year-old female shows left lower lobe bronchiectasis, secondary to tuberculosis.

This HRCT scan demonstrates findings of fluid-filled dilated bronchi in the left lower lobe of a 65-year-old man.

A 27-year-old man diagnosed with reactive airway disease as a child was examined because of frequent respiratory infections. The posteroanterior chest radiograph shows ill-defined pulmonary nodular opacities, mild scoliosis, and moderate overaeration.

A 27-year-old man diagnosed with reactive airway disease as a child was examined because of frequent respiratory infections. This high-resolution computed tomography (HRCT) scan through the upper lungs shows extensive bronchiectasis. The sweat test was positive, and cystic fibrosis was diagnosed.

A close-up radiograph of the left upper lung in a 31-year-old woman with chronic cough since childhood shows nodules in the left upper lung; the right upper lung was similarly involved.

The HRCT scan shows thick-walled, slightly ectatic bronchi. The patient has cystic fibrosis, which was diagnosed and treated since childhood.

A 65-year-old woman was examined for chronic cough. The lateral chest radiograph shows hyperinflation and accentuation of the central bronchial interstitium.

This posteroanterior chest radiograph shows hyperinflation and partially obscured heart borders.

This HRCT scan through the right upper lobe demonstrates bronchiectasis. Despite conventional antibiotic treatment, the patient continued to be symptomatic. Eventually, she underwent bronchoscopy, and sampled cultures grew Mycobacterium avium-intracellulare complex.

A 54-year-old asymptomatic woman with a history of tuberculosis was referred for preoperative chest radiography. The radiograph shows tracheal deviation to the right, an elevated minor fissure, and linear lucencies in the partially atelectatic right upper lung; these findings indicate bronchiectasis.

This lateral chest radiograph shows a partially atelectatic right upper lobe (same patient as in the previous image). The patient has cicatricial tuberculous bronchiectasis.

HRCT scan in a 75-year-old man with cystic bronchiectasis, right worse than left lower lobes.

This HRCT scan in a 13-year-old female shows left lower lobe bronchiectasis, secondary to tuberculosis.

This HRCT scan demonstrates findings of fluid-filled dilated bronchi in the left lower lobe of a 65-year-old man.

Posteroanterior chest radiograph demonstrates central bronchial thickening and widespread bilateral bronchiectasis, worst in the right upper lobe, in this 25-year-old male with cystic fibrosis.

This magnified view of the right upper lobe in a 25-year-old male with cystic fibrosis shows tram tracks and rings, reflecting bronchial thickening. Dilated bronchi filled with mucus are seen as branching tubular opacities.

Axial image from volumetric CT of a 25-year-old male with cystic fibrosis shows thick, dilated bronchi, some with mucus plugging.

Coronal reconstruction from volumetric CT of a 25-year-old male with cystic fibrosis shows thick bronchial walls and dilatation as well as areas of mucous plugging, worst in the right upper lobe.

Coronal reformat from volumetric CT shows tracheomegaly and cystic bronchiectasis of Mounier-Kuhn disease.

Coronal reconstruction image from volumetric CT in patient with rheumatoid arthritis shows upper lobe predominant cylindrical bronchiectasis.