The lung parenchyma demonstrates multi thin-walled cystic cavities with air fluid levels and emphysematous changes located centrally, predominantly in the middle and lower lobe more affecting the left side.
Evidence of cystic bronchiectasis involving the posterior aspect of the left Upper lobe and anterior left lower lobe. Some of the cysts demonstrate air fluid levels.
There is associated bilateral emphysema.
As is true for most lung pathology, bronchiectasis is the common response of bronchi to many different insults. Causes include:
• post-infective (most common)
◦necrotising bacterial pneumonia.
◦allergic bronchopulmonary aspergillosis (ABPA).
◦congenital cystic bronchiectasis
◦cystic fibrosis (CF).
◦ciliary dysfunction syndromes.
◦bronchial cartilage deficiency.
• bronchial obstruction
◦inhaled foreign bodies.
◦chronic aspiration lung changes.
• loss of surrounding lung volume
◦ rheumatoid arthritis.
◦ systemic lupus erythematosus (SLE).
Mnemonic to remember common causes: CAPT KANGAROO HAS MOUNIER KUHN.
According to macroscopic morphology, three types have been described, which also represent a spectrum of severity:
• cylindrical bronchiectasis
◦bronchi have a uniform calibre, do not taper and have parallel walls (tram track sign and signet ring sign).
• varicose bronchiectasis
◦beaded appearances where dilated bronchi have interspersed sites of relative narrowing.
• cystic bronchiectasis
◦severe form with cyst-like bronchi that extend to the pleural surface
◦air-fluid levels are commonly present.