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Bronchiectasis Sicca: A Hidden Cause of Hemoptysis FREE TO VIEW

Gopal Chawla*, MBBS; A. P. Kansal, MD; Amitesh Gupta, MBBS; Vishal Chopra, MD; Amit Kumar, MBBS
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Govt. Medical College, Patiala, India

Chest. 2012;142(4_MeetingAbstracts):884A. doi:10.1378/chest.1389051
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SESSION TYPE: Bronchology Global Case Report Posters

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Bronchiectasis is a permanent abnormal dilatation of bronchi & bronchioles. The disease is characterized by copious amount of productive cough with chronic ill health. This is due to continuous infection by the opportunistic organisms in the abnormally dilated bronchial tree. Bronchiectasis sicca or dry bronchiectasis is a very rare condition in which there are all the features of bronchiectasis except for the absence of copious amount of sputum which is usually a hall mark of bronchiectasis Dry bronchiectasis is rare condition in which abnormal dilataion of trachea bronchial tree is present without infective sputum. The condition has been scarcely reported. We are presenting a case report of an 26 years old male, army man who presented with history of cough since last 2years of training and breathlessness on exertion with frequent episodes of hemoptysis. CT scan confirmed bronchiectasis involving both the lungs.

CASE PRESENTATION: A 26 year old army man presented to our hospital with complaints of breathlessness mostly on exertion , dry cough and episodes of hemoptysis on military and playing bigul in military band for past 18 months. His primary care physician had treated him with antibiotics for bronchitis six times over the previous 18 months. he had no heartburn, acid reflux, choking, or sinus symptoms. There was no systemic inflammatory disease, history of tuberculosis, or other chest infections, such as whooping cough. he had no family history of lung disease. A digital chest radiograph was labelled normal from outside but on careful observation bilateral lower lobe infiltration was observed then HRCT was advised while high resolution chest computed tomography (HRCT) scan showed early bronchiectatic changes in both lungs, mostly cystic and varicose type . Blood tests, including antibody (immunoglobulin) levels, were normal. Pulmonary function testing demonstrated a decrease in lung capacity with mild airflow obstruction.

DISCUSSION: Bronchiectasis was diagnosed, and the patient began on a treatment program that included a bronchodilator, chest physiotherapy, antibiotics, and modified exercise program with advise to avoid playing bigul which is trumpet kind of instrument requiring excessive blowing of air ie traumatic to lungs. Over the next 3 months, his symptoms improved dramatically, although they did not resolve completely. he regained his energy and was able to resume his normal lifestyle that included normal training, , while continuing with his pulmonary treatment program.

CONCLUSIONS: The diagnosis of bronchiectasis is frequently delayed for months or years, often with symptoms misdiagnosed as bronchitis, asthma, or recurrent pneumonia. Symptoms are often downplayed by both the patient and physician. Once diagnosed, bronchiectasis requires a health maintenance program with intermittent treatment of airway infections. This program is usually tailored to the patient’s symptoms and can range from occasional follow-up to frequent hospitalizations for intensive treatment. Chest radiographs or CT scans allow visualization of the dilated bronchi and can also diagnose pneumonia, which is a recognized complication.

1) Luce PM.Bronchiectasis In:Murray JF, Nadel JA eds. Tetbook of Respiratory medicine.2d ed.Philadelphia :Saunders ,1994:1398-417

2) Kolbe J,Wells AU .Bronchiectasis. A neglected cause of respiratory morbidity and mortality.Respirology :1996;1:221-225

3) Grenier P, Maurice F , Musset D et al. Bronchiectasis assesment by thin section CT.Radiology 1986;161:95-99

DISCLOSURE: The following authors have nothing to disclose: Gopal Chawla, A.p. Kansal, Amitesh Gupta, Vishal Chopra, Amit Kumar

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Govt. Medical College, Patiala, India




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