The Rings !!!The Trams!!!, Chest X Ray Findings in Bronchiectasis

Pulmonary Medicine Blog By Dr Deepu

Bronchiectasis is  an abnormal and permanent distortion of one or more of the conducting bronchi or airways.
In 1950, Reid characterized bronchiectasis as cylindrical, cystic, or varicose types.

Types of bronchiectasis

Cylindrical Bronchiectasis
Mild Form shows Tram Track Appearance

Varicose Bronchiectasis
Moderate Form appears as string of pearls

Cystic/ Saccular Bronchiectasis
Severe Form appears like Bunch of Grapes

       Chest radiography Chest radiography (CXR) is usually the initial study performed in both suspected bronchiectasis and the evaluation of nonspecific respiratory symptoms, such as dyspnoea and haemoptysis, when bronchiectasis may be identified incidentally.

Signs on CXR are the identification of
Read This X Ray Before Proceeding Further

1.     Parallel linear densities, tram-track opacities.

what was seen on the chest X ray, it is nothing but the tram line appearance, unable to spot it, here comes the Modified image
Now Compare the previous X Ray with the one above , Here are few examples of tram line shadows
The black arrows points towards tram line and the white to shadows which will be discussed below
Read this X ray before proceeding
What Can we see here
if you have got it proceed further
What we see here is the ring shadows, there are many other ring shadows in the x ray , only a few are  marked
One More X ray below showing the ring shadows in Cystic Fibrosis Patient 

2.     Ring shadows reflecting thickened and abnormally dilated bronchial walls. These bronchial abnormalities  may vary from subtle or barely perceptible 5-mm ring shadows to obvious cysts.
3.      Fluid or mucous filling of bronchi is seen and leads to Tubular branching opacities conforming to the expected bronchial branching pattern.

4.     The Definition of vessel walls is lost due to  peribronchial fibrosis.
5.     Signs of complications/exacerbations, such as patchy densities due to mucoid impaction and consolidation
6.      Volume loss secondary to bronchial mucoid obstruction or chronic cicatrisation, are also seen.
7.     In the more diffuse forms , such as cystic fibrosis (CF), generalised hyperinflation and oligaemia are often present, consistent with severe small airways obstruction.
The radiograph may raise the initial suspicion of bronchiectasis, triggering more definitive imaging. 
CXR also plays a role in the follow-up of bronchiectasis and management of exacerbations.Although CXR has limitations in specificity in diagnosing bronchiectasis and in detecting early or subtle changes, it is useful for assessing more florid cases of bronchiectasis, in CF and in follow-up of bronchiectatic patients. Computed tomography.

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