iatroX Rounds #18
The clues
- 1
A 58-year-old woman presents to her GP with a persistent cough and several months of general lethargy.
- 2
She describes the cough as being most troublesome in the mornings when she expectorates significant amounts of thick, yellow-green sputum.
- 3
She has a history of severe pneumonia as a child and has noticed occasional streaks of blood in her phlegm over the last year.
- 4
Physical examination reveals finger clubbing and coarse inspiratory crackles at the lung bases that partially clear after coughing.
- 5
Routine sputum microbiology repeatedly identifies the presence of Haemophilus influenzae and occasionally Pseudomonas aeruginosa.
- 6
High-resolution CT imaging shows dilated, thick-walled airways with a lack of tapering, and a bronchial-to-arterial ratio greater than one.
Bronchiectasis is a chronic condition characterized by permanent, abnormal dilatation of the bronchi due to a cycle of inflammation and infection. It presents with a chronic productive cough, copious purulent sputum, and recurrent chest infections.
- Daily productive cough with large volumes of purulent sputum
- Coarse inspiratory crackles that clear or shift with coughing
- Association with previous severe respiratory infections such as pertussis or measles
- Finger clubbing and haemoptysis are common clinical features
for education and entertainment. not medical advice.