Internal Medicine

0521779407-B02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

250 Brain Death Bronchiectasis

specific therapy

N/A

follow-up

N/A

complications and prognosis

■Recovery will not occur

Bronchiectasis......................................

PRESCOTT G. WOODRUFF, MD, MPH

history & physical

History

■Typical symptoms: chronic cough, purulent sputum, fever, weak-

ness, weight loss, hemoptysis

■Clues to associated diagnoses: history of TB or severe necrotizing

pneumonia, recurrent sinopulmonary infections, infertility

Signs & Symptoms

■Crackles, rhonchi, wheezes

■Fetid breath

■Digital clubbing (inconstant)

■Clues to associated diagnoses: nasal polyps or chronic sinusitis

tests

■Imaging (critical to making diagnosis of bronchiectasis)

➣Chest xray: may show tram tracks (thin parallel markings that

radiate from the hili), bronchial dilatation, cystic spaces, peri-

bronchial haziness, atelectasis, or consolidation.

➣HRCT: preferred; may show bronchial dilatation, bronchial wall

thickening, lack of normal bronchial tapering, air-fluid levels

➣Sputum analysis: Pseudomonas, other gram-neg organisms, S

aureus, or atypical mycobacterial disease may influence prog-

nosis and guide treatment

➣Serum protein electrophoresis (for alpha-1-antitrypsin defi-

ciency)

➣Immunoglobulin levels, including IgG subclasses, for hypogam-

maglobulinemia

➣Sweat test or genotyping for cystic fibrosis