Bronchiectasis

Bronchiectasis is a common sequel to bronchiolitis of any cause. It may follow the initial insult by weeks, months, or years. This sequence may be called the bronchiolitis-bronchiectasis complex (BBC) to emphasize the relationship. The following images show the radiographic findings in a patient with idiopathic bronchiolitis obliterans and pathologic findings in a patient with heroin overdose.

Radiology

Figure 1. This inspiratory image from a patient with idiopathic bronchiolitis obliterans shows bilateral patchy lucency representing mosaic perfusion due to the presence of air trapping, in addition to dilated bronchi, here most pronounced on the right. The small accompanying arteries, which should be the same diameter as the airways, give a signet ring appearance to the dilated airways.

airway1airway2

 

Find two dilated bronchi and accompanying vessels in the right lung.

Note also the decreased vascularity in the hyperlucent lung.

 

 

Figure 2

This inspiratory image at a different level shows prominent cystic and cylindrical bronchiectasis in the left lung.

Note: This minimum intensity projection image was made by a post-processing technique designed to highlight the morphologic changes associated with airway diseases and other conditions that result in diminished pulmonary parenchymal attenuation.


Pathology

This lung is from a young woman who aspirated gastric contents following a heroin overdose. Six weeks later she died with severe bronchiectasis not present on the initial radiographs. Although bronchiectasis usually evolves over years, it may also develop subacutely.

Figure 3

Cystic and cylindrical bronchiectasis, present bilaterally, were more prominent in the lower lung.

 

Figure 4. This close-up view of the lung shows some dilated thick-walled bronchi, accompanying vessels, and a bronchiole.

bronchiolebronchus1bronchus2

Find a bronchiole (near center) obliterated by grey granulation tissue.

Find two dilated bronchi.

 

The black spots mark respiratory bronchioles with collections of black pigment.

bronchwall

Figure 5

The wall of a bronchus shows replacement of smooth muscle and cartilage by granulation tissue. A fibrinous exudate covers the eroded surface. There was little luminal exudate.

Find the bronchial wall.

Figure 6. This bronchiole is filled with edematous (large empty spaces) granulation tissue. Note the small epithelialized lumen at one edge.

lumen

Find the epithelialized lumen.

Elastic van Gieson stain

Reference:

Warnock M, Ghahremani G, Rattenborg C, Ginsberg M and Valenzuela J. Pulmonary complication of heroin intoxication. JAMA 1974; 219:1051-1053.

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Dilated airway with accompanying artery (signet ring appearance)

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Obliterated bronchiole

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Dilated bronchus

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Granulation tissue of bronchial wall

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Epithelialized lumen

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