Brochiectasis is a disease in which destruction of smooth muscle and elastic tissue by chronic necrotizing infection leads to permanent dilation of bronchi and bronchioles. Nowadays bronchiectasis is not common because of better control of lung infections.
It may still develop in association with;
- Congenital or hereditary conditions; cystic fibrosis, immunodeficiency states etc.
- Infections; bacteria, virus, fungi
- Bronchial obstruction; tumor, mucus impaction, foreign body etc.
- Other conditions; rheumatoid arthritis, eryhtematosus, COPD etc.
- One fourth to one half of the cases are idiopathic.
Obstruction and infection pooling of the secretions distal to the obstruction and secondary infection
Severe infection inflammation with necrosis, fibrosis, dilation of airways
Bronchiectasis usually affects lower lobes bilaterally, most severe in the more distal bronchi and bronchioles.
When tumor is a causative agent the localization may be on a single segment only.
The airways are dilated, sometimes up to four times.
Histologic findings vary associated with chronicity and activity of the disease.
In full-blown, active case there is an intense acute and chronic inflammatory exudation within the walls of bronchi and bronchioles, associated with desquamation of the lining epithelium and extensive areas of the ulceration.
May be pseudostratification of the columnar cells
May be squamous metaplasia
May be abscess – may be
Foul smelling expectoration
Cough paroxysms in the morning due to pus collection and secretions drain.
Robbins & Cotran Pathologic Basis of Disease; 683