Bronchoectatic disease

Description:

Bronchiectasias call irreversible cylindrical or sacculate expansions of a gleam of segmental and subsegmental bronchi. They result from destruction of a bronchial wall which is a consequence of the pneumonia postponed at early children's age, or after a purulent infection. Bronchiectasias in 50% of cases happen bilateral, are localized in the lower shares of lungs or a lingular segment of the left lung.

They can be primary, i.e. independent pathological process (in this case speak about a bronchoectatic disease), or secondary - at tuberculosis, tumors, chronic abscesses of lungs.

Bronchiectasias can be inborn and acquired. Inborn bronchiectasias meet seldom. They are caused by embryonal malformations of bronchial tubes, for example at a cystous hypoplasia of a lung, a cellular lung. Usually in such cases they are combined with other malformations, for example with Kartagener's syndrome (a combination of bronchiectasias to a pansinusitis and situs viscerum inversus), malformations of vertebrae and edges, an esophagectasia, etc.

The acquired bronchiectasias develop at children in the first 3 years of life in 50% of cases against the background of the pneumonia complicating the course of children's acute diseases - measles, whooping cough, etc. Development of bronchiectasias is promoted by also chronic bronchitis, chronic pneumonia, fibrous and cavernous tuberculosis, bronchial asthma, a mucoviscidosis.

Bronchoectatic disease symptoms:

The long-term current with periodic aggravations is characteristic of a bronchoectatic disease. In certain cases patients are disturbed many years only by cough with gradually increasing quantity of a phlegm.
However more often the periods of relative wellbeing are replaced by the periods of aggravations during which body temperature increases, a significant amount of a phlegm is allocated (from 5 to 200-500 ml. and more). The phlegm mucopurulent or purulent, when standing in a vessel is divided into 3 layers (lower - pus, average - serous liquid, upper - slime). Quite often in a phlegm blood streaks are visible. Approximately 10% of patients have pulmonary bleedings. Sources of a pneumorrhagia and bleedings are aneurysmally expanded small vessels in the mucous membrane of bronchial tubes which is exposed to purulent destruction.

Frequent symptoms of an aggravation of pathological process are the stethalgia, an asthma. A classical sign of a bronchoectatic disease - fingers in the form of drum sticks and nails in the form of hour glasses. Quite often these changes are accompanied by the aching extremity pains (the syndrome of a hypertrophic osteoarthropathy described by Pierre Mari and Bamberger).

At survey a part of a thorax on the party of damage of a lung lags behind at breath, especially at patients with atelectatic bronchiectasias. At percussion in this area shortening of a pulmonary sound or dullness is defined. At auscultation large and srednepuzyrchaty wet rattles, usually in the mornings before the patient clears the throat are listened. After expectoration of a large number of a phlegm the dry whistling rattles are quite often listened only.

During remission these blood analyses and urine can not differ from normal. In the period of aggravations the leukocytosis with a deviation to the left appears, SOE increases. Severe forms of a disease are followed by a hypoproteinemia, a hypoalbuminemia. In urine appear protein, cylinders.

X-ray inspection and computer tomography considerably supplement data of a clinical and laboratory trial. Changes are more sharply expressed at atelectatic bronchiectasias. The struck department of a lung comes to light on the roentgenogram in the form of a triangular shadow with top at a lung root. The size of a share is much less than relevant department (a share, a segment) a healthy lung. At an atelectasis of several segments appear also mediastinum shadow shift towards an atelectasis, raising of a dome of a diaphragm on the party of defeat. Sometimes on roentgenograms and especially on computer tomograms ring-shaped shadows (gleams of expanded bronchial tubes), the tyazhisty pulmonary drawing caused by a peribronchitis are visible.

The bronchography gives the chance to precisely characterize features of pathological process and its prevalence. Bronchiectasias come to light in the form of multiple cylindrical or meshotchaty bronchiectasias with accurate contours. In the field of an arrangement of bronchiectasias small branchings of bronchial tubes and an alveolus are not filled with a contrast agent. At an atelectatic form expanded bronchial tubes are pulled together among themselves while in the absence of an atelectasis they hold the usual position.

The clinical and radiological symptomatology of a bronchoectatic disease changes depending on a stage of its development. Allocate three stages of development of a disease corresponding to the stated above stages of morphological changes in lungs.

Stage of I - initial. Rare exacerbations of a disease with a clinical picture of bronchial pneumonia are noted non-constant cough with a mucopurulent phlegm. At a bronchography reveal cylindrical bronchiectasias within one pulmonary segment.

Stage of II and III - stages of infection of bronchiectasias and destruction of pulmonary fabric.

Bronchoectatic disease reasons:

Development of bronchiectasias is promoted by the following factors:

    * changes of elastic properties of a wall of a bronchial tube of the inborn or acquired character;
    * obstruction of a gleam of a bronchial tube a tumor, a purulent stopper, a foreign body or owing to hypostasis of a mucous membrane;
    * increase in intra bronchial pressure (for example, at it is long ongoing cough).

Depending on dominance of this or that factor there are bronchiectasias which are combined with an atelectasis of a part of a lung or without it.

At considerable, but incomplete bronchial obstruction a foreign body or long disturbance of its passability owing to hypostasis of a mucous membrane inflammatory changes in a bronchial tube wall develop. On this background there is an atelectasis of a share or a segment. At its sufficient duration a part of a lung shrivels, negative intrapleural pressure increases that along with increase in intra bronchial pressure can promote expansion of trailer departments of bronchial tubes. Thus the bronchiectasias which are combined with a lung atelectasis (atelectatic bronchiectasias) develop. Stagnation of slime in expanded bronchial tubes and development of an infection in turn is caused by an inflammation of a mucous membrane of a bronchial tube and peribronchial fabric. At the same time there is a transformation of a fleecy epithelium of bronchial tubes in multilayer flat, destruction of elastic and muscular elements of a wall of bronchial tubes. Thereof functional disturbances of bronchial tubes pass into a bronchoectatic disease - the irreversible anatomic changes accruing at each exacerbation of a disease.

Treatment of the Bronchoectatic disease:

Conservative treatment is shown to patients in I and some patients in the II stage of a disease, and also the patient to whom surgical treatment is contraindicated. It will be out by the principles of treatment of acute purulent diseases of lungs stated above. In the III stage carry out surgical intervention.