How is bronchiectasis diagnosed?
Bronchiectasis relies on both a clinical and radiological diagnosis.
Comprehensive medical history taken by GP or respiratory physician including:
History of childhood infection or childhood respiratory symptoms
Family history of bronchiectasis, especially cystic fibrosis
Presence of symptoms to suggest a systemic inflammatory disorder (joint problems, skin rash, muscle pain)
Duration and severity of symptoms
Frequency of infective exacerbations
Peripheral examination for signs of chronic lung disease e.g nail changes (clubbing) occur in some forms of bronchiectasis
Cough quality, strength and sputum production
Signs to suggest a systemic inflammatory disorder (joints, skin, muscles, eyes)
Listening to the chest. Bronchiectasis is characterised by focal or generalised noises (crepitations, crackles, wheeze,) heard with the stethoscope
A high resolution CT scan establishes the diagnosis of bronchiectasis
Findings – bronchial wall dilation (internal lumen diameter greater than the diameter of its adjacent pulmonary artery), failure of the bronchi to taper and visualisation of bronchi in the outer 1-2cm of the lung fields
Generally undertaken when patient is clinically stable
c-HRCT remains the diagnostic gold standard.
As children are at greater risk from radiation-induced cancers later in life, the c-HRCT protocol must ensure the lowest possible radiation exposure to obtain adequate assessment.
As the key radiographic criteria of broncho-arterial ratio in people without lung disease is age-dependent, child specific criteria are recommended (TSANZ Bronchiectasis Guidelines).