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
Smoking history
Presence of symptoms to suggest a systemic inflammatory disorder (joint problems, skin rash, muscle pain)
Duration and severity of symptoms
Frequency of infective exacerbations
Clinical examination:
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
HRCT
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).
