A 45-year-old male presents with a 3-month history of a persistent, productive cough with thick, purulent sputum, recurrent respiratory infections, and occasional hemoptysis. He has a history of childhood recurrent pneumonia. On examination, he has crackles and rhonchi bilaterally. A high-resolution computed tomography (HRCT) scan of the chest is ordered. Which of the following findings on HRCT would be most characteristic of bronchiectasis?
- ACylindrical airway dilation, bronchial wall thickening, and 'signet ring' sign.
- BTree-in-bud opacities and centrilobular nodules.
- CGround-glass opacities and interlobular septal thickening.
- DHoneycombing and traction bronchiectasis.
Show answer & explanationAnswer & explanation
Correct answer: A. Cylindrical airway dilation, bronchial wall thickening, and 'signet ring' sign.
The patient's chronic productive cough, recurrent infections, and hemoptysis are highly suggestive of bronchiectasis. On HRCT, the classic findings of bronchiectasis include permanent, irreversible dilation of the bronchi (cylindrical, varicose, or cystic), bronchial wall thickening, and the 'signet ring' sign, which occurs when a dilated bronchus is seen adjacent to a smaller accompanying pulmonary artery. Options A, C, and D are characteristic of other lung conditions.
Why the other options are wrong
- B. Tree-in-bud opacities and centrilobular nodules are characteristic of small airway disease, such as infectious bronchiolitis or mycobacterial infection.
- C. Ground-glass opacities and interlobular septal thickening are characteristic of interstitial lung diseases or pulmonary edema.
- D. Honeycombing and traction bronchiectasis are findings associated with advanced pulmonary fibrosis, not primary bronchiectasis.
Bronchiectasis HRCT Findings
Bronchiectasis is a chronic lung condition characterized by permanent dilation and damage of the bronchi, leading to impaired mucociliary clearance and recurrent infections. HRCT is the gold standard for diagnosis.
- HRCT is diagnostic.
- Key findings: bronchial dilation, wall thickening.
- 'Signet ring' sign is pathognomonic.
Memory trick: Bronchiectasis: Rings, Tubes, and Thick Walls