Date: 26 November 2013
A Bronchogram showing saccular bronchiectasis
Copyright:
Fungal Infection Trust
Notes:
Bronchography (A & B)is an old technique for visualising the bronchial tree, by introducing radio-opaque dye into the airways and then taking a chest Xray. It was the first means used to diagnose bronchiectasis, seen in these examples below. An historical description of the technique from 1922 can be seen here
Nowadays CT scanning of the chest is used for this purpose with 3D reconstruction in some cases.
White cell scan (C) This pair of white cell scans from different people show almost no white cells in the lungs on the left, as in a healthy person (the spleen is the ‘hottest area). The scan on the right shows grossly increased update, especially in the left lung (seen on the right). This is the typical feature of severe bronchiectasis with large amounts of neutrophils and other phagocytes present.
Sinusitis Plain X-ray (D) of the face showing the maxillary sinuses. The right maxillary sinus is complete fluid filled and the left side (seen on the right) has a fluid level. These features may be seen with severe acute bacterial sinusitis, but also other causes of sinusitis, including allergic rhinosinusitis.
Images library
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PtDS2 –Repeated chest infections arrested by itraconazole therapy in ABPA and bronchiectasis
DS2 developed asthma age 24 and now aged 62. From about age 30 she started getting repeated chest infections and a few years later ABPA and bronchiectasis was diagnosed. Infections continued requiring multiple courses of antibiotics annually. At one point DS2 developed a pneumothorax, possibly because of excess coughing. She has chronic rhinitis and mannose binding lectin deficiency. In May 2011, she started itraconazole therapy, and has needed no antibiotic courses for her chest since. Her rhinitis with sinusitis occasionally bothers her. She is delighted to have gone 18 months with no chest infections.
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Aspergillus hyphae (arrow) in the lumen without invasion of the necrotic bronchial wall (*) (Nicod 2001).
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fibrinonecrotic material (arrow) from the airway shown in A, with subocclusion of the bronchial lumen (*)
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Fibrinous or pseudomembranous bronchitis (arrow) with subocclusion of the airways (* indicates subocclusion of the airways by pseudomembranes)
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Bronchoscopic biopsy demonstrated septate hyphae with branching at 45o (methenamine silver stain ×400).
