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Summary of recommendations and good practice points
How should the diagnosis of bronchiectasis be determined?
Recommendations – Imaging
Perform baseline chest X-ray in patients with suspected bronchiectasis. (D)
Perform a thin section computed tomography scan (CT) to confirm a diagnosis of bronchiectasis when clinically suspected. (C)
Perform baseline imaging during clinically stable disease as this is optimal for diagnostic and serial comparison purposes. (D)
Good practice points
CT imaging protocol
The most appropriate imaging protocol will vary according to scanner technology and patient factors.
When using volumetric CT, dose reduction techniques including adaptive mA and kV and iterative reconstruction should be utilised where available.
Typical CT imaging parameters for the diagnosis of bronchiectasis are:
Slice thickness: ≤1mm
Reconstruction algorithm: – high spatial frequency
mAs (or effective mAs): 100 – 200
Gantry rotation time: <0.5s
CT features of bronchiectasis
Bronchiectasis is defined by bronchial dilatation as suggested by one or more of the following:
Bronchoarterial ratio >1 (internal airway lumen vs adjacent pulmonary artery)
Lack of tapering
Airway visibility within 1cm of costal pleural surface or touching mediastinal pleura.
The following indirect signs are commonly associated with bronchiectasis:
Bronchial wall thickening
Mosaic perfusion / air trapping on expiratory CT
CT scanning can also aid in identifying an aetiology of bronchiectasis eg Allergic bronchopulmonary aspergillosis (ABPA), Non-tuberculous mycobacteria (NTM), primary ciliary dyskinesia, alpha one antitrypsin deficiency, Williams Campbell syndrome and a foreign body.
In whom should the diagnosis of bronchiectasis be suspected?
Consider investigation for bronchiectasis in patients with persistent production of mucopurulent or purulent sputum particularly with relevant associated risk factors. (D)
Consider investigation for bronchiectasis in patients with rheumatoid arthritis if they have symptoms of chronic productive cough or recurrent chest infections. (C)
Consider investigation for bronchiectasis in patients with Chronic Obstructive Pulmonary Disease (COPD) with frequent exacerbations (two or more annually) and a previous positive sputum culture for P. aeruginosa whilst stable. (B)
Consider investigation for bronchiectasis in patients with inflammatory bowel disease and …
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