Postgraduate Institute of Medical Education and Research, Chandigarh, India
Correspondence to: Ritesh Agarwal, MD, DM, Assistant Professor, Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh-160012, India; e-mail: firstname.lastname@example.org
I read with interest in a recent issue of CHEST (June 2007)1the case report “A 53-Year-Old Man With Fever, Clubbing, Hemoptysis, and Rapid Onset of Respiratory Failure,” wherein the authors described an occurrence of isolated pulmonary capillaritis and usual interstitial pneumonia in a patient with undifferentiated connective-tissue disease. However, I do not agree with the description of the CT scan findings as dense alveolar consolidations and bronchiectasis. The patient does not have bronchiectasis, which is defined as permanent destruction of the bronchi. Instead, the patient has only dilated bronchi, which is a common reversible finding seen in patients with pneumonia of any cause and is referred to as pseudobronchiectasis2or functional bronchiectasis.3
As a result of either infection or inflammation of the bronchi, dilatation of the bronchi can occur. The process is reversible, because following control of the infection or inflammation the dilatation disappears.4It is only after destruction of the elastic tissue and bronchial musculature and replacement by scar tissue that the anatomic change so characteristic of bronchiectasis is seen.5 A study4 of 60 consecutive cases of pneumonia in previously asymptomatic adults revealed 25 patients with bronchial dilatation during the acute phase of the illness, with 20 of those patients subsequently returning to normal. As the bronchial dilatation may persist for up to 3 to 4 months after the resolution of acute pneumonia, a consequent high-resolution CT scan examination for bronchiectasis6should be performed at least 6 months after the infection has resolved to avoid this pitfall and to confirm the diagnosis of bronchiectasis.7–8
The author has reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
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