=Bronchiectasis= is a dilatation of a part or the whole of the
bronchial tube. As a rule this affection is a secondary one, the most
common cause being chronic bronchitis. The inflammation weakens the
bronchial walls so that they are unable to resist the strain that is
put upon them during violent paroxysms of coughing. After dilatation
has once commenced, the weight of the secretion which accumulates tends
to further distend the weakened walls and the elasticity, becoming
impaired, is finally lost. Dilatation of the bronchi is also associated
with emphysema, compression of a bronchus, aneurism or mediastinal
tumor, bronchopneumonia, measles and whooping cough in children, and
also traction associated with fibroid induration. Hence the bronchial
dilatation is especially associated with bronchitis, interstitial
pneumonia, and sometimes chronic pleurisy. It is rarely a congenital
effect in such cases. It is commonly unilateral. The lesions presented
to the osteopath are largely like those found in chronic bronchitis,
i. e., derangement of the upper four or five dorsal vertebræ and ribs,
and lesions of the cervical vertebræ involving the vagi. These lesions
obstruct the nerve force to the bronchial tubes and thus cause the
dilatation.
=Pathologically=, the dilatation is usually either cylindrical or
saccular, which may occur in the same lung. The entire bronchial tree
may be converted into a series of sacs opening into each other. These
have smooth, shining walls in the most dependent parts which are
sometimes ulcerated. In extreme conditions the dilatations may form
large cysts immediately beneath the pleura; as a rule, the lung tissue
lying between the sacculi becomes cirrhotic. =Partial dilatation=
is more common. The bronchial mucous membrane is involved with an
occasional narrowing of the lumen. The narrowings are most commonly
cylindrical, sometimes saccular.
In all forms there is decided change in the bronchial wall. In the
large dilatations, the epithelium is changed. The elastic and muscular
layers are thin and atrophied. These dilatations frequently contain
fetid secretions and when these secretions are retained, the lining
membrane becomes ulcerated.
=Symptoms.=—There is always cough, which occurs in severe paroxysms. In
some cases a change of position will cause a paroxysm of coughing—very
likely due to the emptying of the contents of a dilated tube into
a normal one. The sputum is mucopurulent and is greenish brown in
color, is fluid, and has a sour, or more frequently, a fetid odor.
On standing, it separates into three layers; the upper is frothy and
thin, the middle mucoid, and the lower is a thick sediment of cells
and granular debris. Microscopically, the sediment consists of pus
corpuscles, fatty acid crystals which are arranged in the form of
bundles, and sometimes red blood discs and hematoidin crystals. Elastic
fibers may be found if ulcers are present.
=Physical Signs.=—When distinctly present, they are those of a cavity
in the lungs. When chronic pleurisy and interstitial pneumonia are
associated, there may be retraction of the chest wall. The percussion
resonance is impaired. On auscultation, bronchial, or even amphoric,
breathing is heard occasionally with metallic rales.
=Diagnosis.=—In a number of cases this was formerly impossible, where
the X-ray is now proving of great assistance. History, paroxysmal
cough, characteristic copious sputum and an absence of tubercle bacilli
with little impairment of the general health will serve to distinguish
bronchiectasis from pulmonary tuberculosis. Circumscribed empyema which
has ruptured into the lung may simulate bronchiectasis. This is of a
much more sudden onset, has a history of previous pleurisy, the health
is gradually impaired, and there is thoracic oppression and dyspnea on
the slightest exertion.
=Prognosis.=—Is generally unfavorable. However this largely depends
upon the cause.
=Treatment.=—Largely the same as in chronic bronchitis. Severe lesions
are found in the dorsal vertebræ about the region of the third, fourth
and fifth, and many times lesions of the pneumogastric at the upper
cervical vertebræ are also found. The lesions are much of the same
nature as those of bronchitis, but, as a rule, there is a much deeper
or more extensive lesion. These lesions weaken the motor innervation to
the muscular coats of the bronchial tubes, and in many instances the
extensive lesions involve the vasomotor nerves controlling the blood
supply to the bronchial tubes. In most cases marked lesions of the ribs
on either side will be found, usually in the region corresponding to
the affected vertebræ.
The position of the patient is important; the head should be low in
sleeping. In certain fetid cases surgery should be considered.
Care should be taken as to the hygienic surroundings of the patient.
The diet should be carefully regulated and nutritious, as in chronic
bronchitis.