Diagnostic Imaging Pathways - Bronchiectasis
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This pathway provides guidance on imaging patients with suspected bonchiectasis.
Date reviewed: February 2012
Date of next review: January 2015
Published: February 2012
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The relative radiation level of each imaging investigation is displayed in the pop up box.
| SYMBOL | RRL | EFFECTIVE DOSE RANGE | |
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None | 0 | |
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Minimal | < 1 millisieverts | |
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Low | 1-5 mSv | |
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Medium | 5-10 mSv | |
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High | >10 mSv |
Images
Image GalleryNote: These images open in a new page | ||
|---|---|---|
| 1a |  |
Cystic Bronchiectasis Image 1 (Plain Radiograph): Severe cystically dilated bronchi most marked in the upper lung zones bilaterally due to cystic fibrosis.
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| 2 |  |
Cystic Bronchiectasis Image 2 (Computed Tomography): Multicystic space within the base of the left lower lobe which is continuous with the small airways and is representative of cystic bronchiectasis. |
| 3a |  |
Cystic Bronchiectasis Image 3a: Pneumonectomy showing grossly dilated bronchi with mucous plugging (blue arrows) and distal consolidation. |
| 3b |  |
Image 3b (H&E, x2.5): Section of a dilated bronchi with florid acute on chronic inflammation of the bronchial wall and surrounding interstitial fibrosis. |
Teaching Points
Teaching Points
- Bronchiectasis is irreversible dilatation of the bronchial tree
- A chest radiograph is useful to exclude other causes of the patients symptoms. In severe disease, it can demonstrate changes of bronchiectasis
- A High Resolution CT is the imaging modality of choice to define the type and extent of bronchiectasis but increasingly low dose helical CT is also being used for bronchiectasis
hrct
Chest Computed Tomography (CT)
- CT is the imaging investigation of choice to identify and define the type and extent of bronchiectasis 1,2,7
- Use of Helical MDCT with thin collimation instead of conventional HRCT has the advantage of contiguous data acquisition and has been shown to be more accurate in the detection of bronchiectasis. 11 However, radiation dose is also significantly increased with the use of MDCT with thin collimation 12
- HRCT was preferred to MDCT with thin collimation for ground glass opacities in one study 13
- Choice of scanning technique depends on the clinical scenario and the age of the patient. Younger patients (especially females) should have HRCT if clinically acceptable
- High sensitivity of 84-95% and specificity of 93-100% for detection and determining the extent of bronchiectasis 8,9,10
- CT appearances of bronchiectasis depend on the bronchiectatic pattern,
as defined by Reid's classification and on the orientation of the bronchus
in relation to the plane of scanning 1
- Cylindrical bronchiectasis is classified depending on a horizontal or vertical course of the bronchi in the scan plane as "tramlines" or "signet rings"
- Varicose bronchiectasis shows a greater degree of dilatation and the walls of the dilated bronchi assume a beaded appearance
- Cystic bronchiectasis can be recognised by air-fluid levels, strings, or cluster of cysts
- Other CT findings of bronchiectasis include a lack of tapering of the bronchial lumina, bronchial internal diameter greater than that of the adjacent pulmonary artery, visualized bronchi within 1 cm of the pleura, and mucus-filled dilated bronchi 9,17,18
- There is a significant linear relationship between the severity of bronchiectasis at HRCT and abnormalities as seen on the chest radiograph 5
- Thick slice helical CT is not effective at excluding clinically significant bronchiectasis.
Low Dose Helical CT
- Studies have shown that low dose helical CT (at 120kV, 3 mm collimation, pitch of 2, and reconstruction interval of 2 mm, 24-sec breath hold and 40 mA) has comparable radiation dose of 3.21 mGy to that of HRCT (at 120kV, 1-sec scan time, 10 mm intervals, 1 mm collimation and 170 mA) radiation dose of 2.17 mGy 14
- Helical CT due to volumetric acquisitions is superior in contiguous image acquisition resulting in more lung segments being visualized, better follow through of bronchi and pulmonary vessels, less motion artifacts and potentially higher rate of visualizing small lung nodules compared to standard HRCT 14,16
xray
Plain Chest Radiograph (CXR)
- Initial investigation to exclude other causes for the patient's symptoms 1,2
- Sensitivity (37-47%) and specificity 95% for diagnosing bronchiectasis when bronchography used as gold standard 3,4
- More recent study reported 87% sensitivity and 74% specificity when plain radiographic findings were compared to HRCT 5
- Radiographic manifestations are non-specific. Positive findings include increased linear markings, crowding, cystic spaces and honeycombing 1,2,6
- Limitations 1,2,3,4
- May be normal in mild disease
- Underestimates the severity and the extent of disease
References
References
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Tasker AD, Flower CDR. Imaging the airways: hemoptysis, bronchiectasis, and small airways disease. Clin Chest Med. 1999;20:761-73. (Review article)
- Kumar NA, Nguyen B, Maki D. Bronchiectasis: current clinical and imaging concepts. Semin Roentgenol. 2001;36(1):41-50. (Review article)
- Currie DC, Cooke JC, Morgan AD, et al. Interpretation of bronchograms and chest radiographs in patients with chronic sputum production. Thorax. 1987;42:278-84. (Level III evidence)
- Cooke JC, Currie DC, Morgan AD, et al. Role of computed tomography in diagnosis of bronchiectasis. Thorax. 1987;42:272-7. (Level III evidence)
- Van der Bruggen-Bogaarts BAHA, Van der Bruggen HMJG, Van Waes PFGM, et al. Screening for bronchiectasis: a comparative study between chest radiography and high resolution CT. Chest 1996;109:608-11. (Level II/III evidence). View the reference
- Gudberg CE. Roentgenologic diagnosis of bronchiectasis: an analysis of 112 cases. Acta Radiol. 1955;195:649-54. (Level III evidence)
- Grenier P, Cordeau M-P, Biegelman C. High-resolution computed tomography of the airways. J Thorac Imaging. 1993;8:213-29. (Review article)
- Munro NC, Cooke JC, Currie DC, et al. Comparison of thin section computed tomography with bronchography for identifying bronchiectatic segments in patients with chronic sputum production. Thorax. 1990;45:135-9. (Level II/III evidence). View the reference
- Kang EY, Miller RR, Muller NL. Bronchiectasis: comparison of preoperative thin-section CT and pathologic findings in resected specimens. Radiology. 1995;195:649-54. (Level IV evidence)
- Grenier P, Maurice F, Musset D, et al. Bronchiectasis: assessment by thin-section CT. Radiology. 1986;161:95-9. (Level III evidence)
- Dodd JD, Souza CA, Muller NL. Conventional high-resolution CT versus helical high-resolution MDCT in the dectection of bronchiectasis. AJR Am J Roentgenol. 2006;187:414-20. (Level IV evidence)
- Leswick DA, Webster ST, Wilcox BA, Fladeland DA. Radiation Cost of Helical High-Resolution Chest CT. AJR Am J Roentgenol. 2005;184:742-5 (Level II evidence). View the reference
- Studler U, Gluecker T, Bongartz G, Roth J, Steinbrich W.
Image quality from high-resolution CT of the lung: comparison of axial
scans and of sections reconstructed from volumetric data acquired using MDCT.
AJR Am J Roentgenol. 2005;185:602-7 (Level IV evidence)
- Jung K-J, Lee KS, Kim SY, Kim TS, Pyeun YS, Lee JY. Low dose, volumetric helical CT: Image quality, radiation dose, and usefulness for evaluation of bronchiectasis. Invest Radiol. 2000;35:557-63. (Level II/III evidence)
- van der Bruggen-Bogaarts BAHA, van der Bruggen HMJG, van Waes PFGM, Lammers JWJ. Assessment of bronchiectasis: Comparison of HRCT and spiral volumetric CT. J Comput Assist Tomogr. 1996;20:15-19. (Level III evidence)
- Lucidarme O, Grenier P, Coche E, Lenoir S, Aubert B, Beigelman C. Bronchiectasis: Comparative assessment with thin-section CT and helical CT. Radiology. 1996;200:673-9. (Level III evidence)
- Lynch DA, Newell JD, Tschomper BA, Cink TM, Newman LS, Bethel R. . Uncomplicated asthma in adults: Comparison of CT appearance of the lungs in asthmatic and healthy subjects.Radiology. 1993;188:829-33. (Level III evidence)
- McGuinness G, Naidich DP. Leitman BS, McCauley DI. Bronchiectasis:CT evaluation. AJR Am J Roentgenol. 1993;160:253-9. (Review article)
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