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Wednesday, 27 November 2013

Bronchiectasis (Respiratory Disease) – The Diagnosis

Respiratory Disease is defined as medical conditions, affecting the breathing organ and tissues including Inflammatory lung disease, Obstructive lung diseases, Restrictive lung diseases, Respiratory tract infections, trachea, bronchi, bronchioles, alveoli, the nerves and  muscles breathing , etc,.
Bronchiectasis
Bronchiectasis  is defined as a condition chracterized by the damage of the localized, irreversible dilation of part of the bronchial tree and the walls of the large airways of the lung as a result of the destruction of the lung muscles and elastic tissues. Bronchiectasis can be present alone, but in most cases, it is a disease coexisted with patient of chronic obstructive pulmonary disease (COPD).
E. Diagnosis
If you are experience the above symptoms, you doctor may suspect that you have developed broncholithiasis. After recording your family history and completing the physical exam, the test which your doctor orders include
 1. Blood test
The aim of the blood test is to check for underline causes of  broncholithiasis as well as any infection of
the lungs or breathing passages.
2. A sputum culture
A sputum culture is to identify bacteria or fungi that infect the lungs or breathing passages.
3. Bronchoscopy
Bronchoscopy is considered the most important diagnostic test for broncholithiasis. In retrospective review of the clinical data of patients with broncholithiasis who also underwent bronchoscopy at Mayo Clinic, Forty-eight percent (23 of 48) of the partly eroding broncholiths were successfully removed bronchoscopically, with a greater percentage removed with the rigid bronchoscope (67%) than with the flexible bronchoscope (30%). All free broncholiths were completely extracted regardless of the type of bronchoscope used. Complications occurred in only two patients (4% of the bronchoscopic broncholithectomy group), both with partially eroded broncholiths, and consisted of hemorrhage in one patient requiring thoracotomy and acute dyspnea in another patient, caused by a loose broncholith lodged in the trachea. We conclude that flexible and/or rigid bronchoscopic extraction of partly eroded or free broncholiths in the tracheobronchial tree can be considered safe and effective(33).
4. Chest CT scan
CT can suggest the diagnosis of broncholithiasis and is useful when bronchoscopy does not show a broncholith, according to the study byBroncholithiasis: CT features in 15 patients(34).
5. Chest X ray
The aim of the test is to observe any abnormality in the lung causes of broncholithiasis.
6. High resolution computed tomography (HRCT), laminograms and Friberoptic bronchoscopy ( FOB )
According to the study to evaluate high resolution computed tomography (HRCT) in the diagnosis of broncholithiasis, researchers at the Service central de Radiologie et Imagerie Médicale, indicated that
in 9 cases, chest X rays were abnormal but the diagnosis of broncholithiasis can’t never be affirmed. In 9 cases, FOB was abnormal: broncholith were identified in only 2 cases; the other diagnosis were tumor like stenosis (n = 3), inflammatory stenosis (n = 3), extrinsic compression (n = 1). On conventional CT scan, broncholithiasis was suspected in 8 patients but because of volume averaging the relationship between calcified lymph nodes and bronchial tree was difficult to determine exactly. Only HRCT sections, sometimes tilted in the axis of the middle lobar bronchus, can affirm the endobronchial or peribronchial location of calcified lymph nodes in all patients(35).
In other study to assess the validity and reliability of the Korean version of chronic obstructive pulmonary disease assessment test (CAT) and Dyspnea-12 Questionnaire for patients with bronchiectasis or tuberculous destroyed lung, showed that Korean version of CAT and Dyspnea-12 are valid and reliable in patients with tuberculous destroyed lung and bronchiectasis(36).
Another study indicated that in 8 of the 19 patients, laminograms or chest CT scans helped establish the diagnosis; FOB was performed on 18 patients and was abnormal in each case, with 8 intrabronchial calcifications identified. However, fiberoptic bronchoscopy ( FOB ) has limited therapeutic indications in this disorder(37).
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Sources
(33) http://www.ncbi.nlm.nih.gov/pubmed/10471594 
(34) http://www.ajronline.org/content/157/2/249 
(35) http://www.ncbi.nlm.nih.gov/pubmed/18318256 
(36) http://www.ncbi.nlm.nih.gov/pubmed/23101012
(37) http://www.ncbi.nlm.nih.gov/pubmed/6732045