The first choice for bronchiectasis examination, common examination items

The most obvious symptom of bronchiectasis is chronic cough, large amounts of thick sputum, and repeated hemoptysis. It requires early treatment. The most basic and common examination for bronchiectasis is chest X-ray, which can provide a good diagnosis.

1. Chest X-ray: Mild cases usually show no abnormal findings. In severe cases, the lung texture in the lesion area increases, thickens, and is disordered. Sometimes, columnar thickening of the bronchi or "track sign" can be seen. The shadows are typically honeycomb or curly, with cystic areas of fluid levels in between.

This is the most basic X-ray examination. A small number of patients with bronchiectasis (less than 10%) have completely normal plain films, but if you read the films carefully, most of them have some changes. However, these changes are often non-specific and cannot make a reliable judgment. To make a clear diagnosis, bronchography must be performed.

Bronchiectasis ranges from mild to severe, and the pathological changes are very complex, involving the bronchi, lung parenchyma and pleura. Chest X-rays reflect the gross pathological anatomy, so what is seen on the film is also varied.

(1) Due to chronic infection of the bronchial wall, thickening of the bronchial wall and proliferation of the surrounding connective tissue, the lung texture in the affected area increases, becomes thicker and disordered, and is still obvious in the outer lung zone. If the thickened bronchial wall contains air, parallel double thick lines can be seen on the film, which is called the "double track sign". If there is pus retention, it will appear as thick strips or even clubbed. The enlarged bronchi appear as circular shadows on the cross section. If multiple small circular shadows gather together, they appear like a honeycomb. Large cystic dilatation can be seen with multiple round or oval translucent areas, ranging in size from a few millimeters to 2 to 3 cm. The lower edge wall is thickened and visible, resembling curly hair, also known as the "curly hair sign". Sometimes there is also fluid level in the cyst cavity.

(2) Bronchiectasis is accompanied by pulmonary parenchymal inflammation. During acute attacks, there are local patchy shadows. After the acute infection disappears, small patchy and blocky lesions and fibrosis are often left. Therefore, the lung volume is often reduced, accompanied by corresponding changes: convergence of lung texture, increased density, displacement of lung fissures, reduction, displacement and shift of hilar shadows, compensatory emphysema in areas without lesions, and ultimately atelectasis. If the bilateral lower lobe atelectasis is very small, it may be attached to the mediastinum and difficult to detect on plain film. Atelectasis of the right upper lobe may appear as widening of the superior mediastinum. Right middle lobe atelectasis may be just a blurred area at the right cardiac border, which is sometimes difficult to distinguish from thickening of the oblique fissure on the lateral view. The left lower lobe is a common site for bronchiectasis. When the lower lobe shrinks in size, it completely overlaps with the heart shadow on the plain film and is easily missed. However, if there is a lateral view and attention is paid to changes in the left hilum and left lung texture, it is not difficult to find.

(3) Pleural changes. Patients with bronchiectasis often suffer from repeated lung infections, which sometimes affect the pleura and cause inflammation and adhesions. Therefore, many pleural changes can be seen on the films. Extensive and severe bronchiectasis, atelectasis, fibrosis, and thickened pleura will cause dense shadows to appear in one lung, diaphragm elevation, and mediastinal displacement. Luminous areas of bronchiectasis can be seen in the dense shadows, which is the so-called "damaged lung."

(4) Late-stage bronchiectasis may affect the heart, causing pulmonary hypertension, dilation of the pulmonary artery at the hilum, thinning of the peripheral lung texture, and an enlargement of the cardiac shadow. The most common sites for bronchiectasis are the bilateral lower lobes, the middle lobe, the left lower lobe plus the lingular segment, and the right middle and lower lobe. Therefore, the changes on chest X-rays are often limited to these areas. The range can be clearly defined with AP and lateral views. Even in the case of extensive bilateral bronchiectasis, some bronchi are often normal.

2. Bronchial iodized oil contrast: bilateral bronchial contrast can confirm the diagnosis, not only to understand the shape of the dilation, but also to identify the location and range of the lesion. Cystic, columnar or cystic-columnar changes may be found and are currently only used before surgery. In the following cases, although other examinations highly suspect bronchiectasis, bronchography can be temporarily omitted:

① If there are obvious extensive lesions on both sides of the chest X-ray, surgery is definitely not possible.

② For those who are older, such as those over 50 to 60 years old, surgery is generally not considered.

③Poor cardiopulmonary function and no conditions for surgery.

④ If the symptoms are mild, the number of attacks is small, the inflammation is easy to control, and surgery is not considered for the time being, the examination can be postponed (but in the long run, it is advisable to examine such patients because the lesions may progress and there is often no obvious cause for massive hemoptysis. If the site of bronchiectasis is clearly identified after angiography, there will be a basis for surgery thereafter).

⑤The patient or family members refuse examination. When performing angiography for surgery, both sides should be done even if one side of the chest radiograph is completely normal, because the incidence of bilateral bronchiectasis is quite high. Bilateral angiography can be completed in one session or in two separate sessions, depending on the patient's tolerance and the angiologist's experience. The split-side procedure is technically simpler and easier for patients to tolerate. The images are generally of better quality, with no overlap problems, and are easier to read. Performing bilateral surgery simultaneously can avoid the pain of another examination. When the body is positioned correctly during X-ray, both sides can be clearly displayed. However, if the anesthesia is not perfect or the patient cannot tolerate it, the originally planned bilateral surgery often has to be terminated after one side is completed. For those who have had a recent lung infection, it is best to wait three months after the pneumonia disappears before doing the test, because the dilated bronchi may return to normal after the inflammation disappears (this was called "reversible bronchiectasis" in the past). If you have a cough with a lot of phlegm, try to take medication first to reduce the phlegm before doing it. When the bronchi are inflamed, it is difficult to tolerate the stimulation of contrast agents. Severe coughing can easily cause the contrast agents to be coughed out, resulting in unsatisfactory results. Frequent coughing during surgery also makes it difficult to observe clearly. In cases of excessive phlegm, it can block individual bronchi, causing poor filling and making it impossible to determine the nature of the phlegm. Avoid contrast imaging during hemoptysis to prevent severe hemoptysis. For patients with mild hemoptysis (such as several mouthfuls of bloody sputum every day) who have not completely recovered after long-term treatment, contrast imaging can be performed. However, patients with severe hemoptysis must be examined 2 weeks after the bleeding stops.