Bronchiectasis represents an abnormal permanent di lation of the bronchi,

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typically on the basis of chronic destruction and inflammation caused by repetitive infection or other
chronic insults. Many infectious agents, including adeno virus, influenza virus, S. aureus, tuberculosis,
and anaerobic infection, can each predispose a patient to the bronchiectatic state. Problems of
primary immune defenses such as im munoglobulin deficiency, primary cilliary disorders, and cystic
fibrosis also can produce dilated bronchi. This anatomic problem leads to recurring cough and
purulent sputum production, frequently associated with hemoptysis resulting from friable, inflamed
airway mucosa. Repetitive bronchiectatic episodes tend to produce increased problems. Physical
examination is nonspecific; however, the chest radiograph is frequently abnormal, and the f indings
may include cystic spaces caused by saccular bronchiectasis or the so-called tram track (parallel
linear shadows) or rings (produced if the inflamed thickened airways are seen in cross section).
Treatment requires elimination of the underlying problem (e.g., by immunoglobulin infusions),
improved clearance of tracheobronchial secretions, control of infection, and the use of
bronchodilators to reverse airflow obstruction.