Question
A patient presented with chronic cough with foulsmelling sputum production, haemoptysis and recurrent pneumonia.Lung shows the following features.What can be the most probable diagnosis?
A. Emphysema.
B. Chronic Bronchitis.
C. Bronchial Asthma.
D. Bronchiectasis.
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Correct Answer » D Explanation |
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Ans:D. Bronchiectasis.
Image shows:honey-combed appearance of the lung.
BRONCHIECTASIS
- Bronchiectasis is defined as abnormal and irreversible dilatation of the bronchi and bronchioles (greater than 2 mm in diameter) developing secondary to inflammatory weakening of the bronchial walls.
- The most characteristic clinical manifestation of bronchiectasis is persistent cough with expectoration of copious amounts of foul-smelling, purulent sputum.
MORPHOLOGIC FEATURES.
- The disease characteristically affects distal bronchi and bronchioles beyond the segmental bronchi.
- Grossly, the lungs may be involved diffusely or segmentally. Bilateral involvement of lower lobes occurs most frequently.
- More vertical air passages of left lower lobe are more often involved than the right.
- The pleura is usually fibrotic and thickened with adhesions to the chest wall.
- The dilated airways, depending upon their gross or bronchographic appearance, have been subclassified into the following different types :
- Cylindrical: the most common type characterised by tube-like bronchial dilatation.
- Fusiform: having spindle-shaped bronchial dilatation.
- Saccular: having rounded sac-like bronchial distension.
- Varicose: having irregular bronchial enlargements.
- Cut surface of the affected lobes, generally the lower zones, shows characteristic honey-combed appearance.
- The bronchi are extensively dilated nearly to the pleura, their walls are thickened and the lumina are filled with mucus or muco-pus. The intervening lung parenchyma is reduced and fibrotic.
Microscopically, fully-developed cases show the following histologic features :
- The bronchial epithelium may be normal, ulcerated or may show squamous metaplasia.
- The bronchial wall shows infiltration by acute and chronic inflammatory cells and destruction of normal muscle and elastic tissue with replacement by fibrosis.
- The intervening lung parenchyma shows fibrosis,while the surrounding lung tissue shows changes of interstitial pneumonia.
- The pleura in the affected area is adherent and shows bands of fibrous tissue between the bronchus and the pleura.
