DOSEN : dr. Sutaryanu, Sp.

Rad

Amadea Rigenastiti
( 42180283)
 Bronkiektasis adalah suatu penyakit yang
ditandai dengan adanya dilatasi bronkus yang
bersifat patologis dan berlangsung kronik.
KONGENITAL
• Terjadi sejak individu DIDAPAT
masih dalam kandungan. • Infeksi
• Mengenai hampir seluruh • Penyumbatan bronkus
cabang bronkus pada satu • Cedera penghirupan
atau kedua bronkus. • Kelainan immunologik
• Menyertai penyakit- • Keadaan lain
penyakit kongenital
seperti Fibrosis kistik,
Sindroma Kartagener,
William Campbell
syndrome, Mounier-Kuhn
syndrome, dll
• Infeksi paru berulang
• Asma, ppok
• GERD
• Massa pada paru
• Merokok
• Inhalasi gas toksik
• Penggunaan obat narkotik terutama heroin
• Imunodefisiensi
• Batuk-batuk sudah bertahun-tahun (kronik) disertai dengan sputum yang
berbau nanah atau busuk
• Sputum yang bercampur darah (hemoptisis) dapat terjadi akibat nekrosis atau
destruksi mukosa bronkus yang mengenai pembuluh darah dan menimbulkan
perdarahan
• Demam, sianosis
• Dahak berupa mukus (akut) sampai purulen (kronik)
• Penderita sering mengeluh sesak (tanpa/wheeze), namun kadang
menimbulkan mengi akibat adanya obstruksi bronkus
• Jumlah dahak ±10-150 ml/hari (10 ml : ringan, 10-150 ml : sedang, >150 ml :
berat)
• Clubbing finger
• Ronki basah pada lobus bawah paru
- Ronki
- Wheezing
- Perkusi redup
- Fremitus meningkat
- Clubbing finger
9
 (A–C) NORMAL RADIOGRAPHIC ANATOMY.
Posteroanterior chest radiographs. a, aorta; ajl, anterior junction line; apw,
aortopulmonary window; ca, carina; cap, cardiophrenic angle; cl, clavicle;
cpa, costophrenic angle; d, diaphragm; g, gastric air bubble; ip, interlobar
(or descending) pulmonary artery; L, liver; la, left atrium; lv, left ventricle;
p, main pulmonary artery; pjl, posterior junction line; rts, right tracheal (or
paratracheal) stripe; s, scapula; sf, splenic flexure of colon; sp, spleen; t,
trachea.
 (A,B) NORMAL RADIOGRAPHIC ANATOMY. LATERAL CHEST RADIOGRAPHS.
a, aorta; bi, bronchus intermedius; cpa, costophrenic angle; d, diaphragm; e, esophagus;
ivc, inferior vena cava; lpa, left pulmonary artery; lul, left upper lobe bronchus; lv, left
ventricle; m, manubrium; mf, minor fissure; MF, major fissure; rpa, right pulmonary
artery; rul, right upper lobe bronchus; rv, right ventricle; st, sternum; svc, superior vena
cava; t, trachea; v, vertebral body.
(A–H) Normal CT anatomy. Axial scans of the chest, contiguous slices at approximately 1 cm
collimation, lung window settings. bb, basilar segmental bronchi of lower lobes; bi,
bronchus intermedius; ca, carina; e, esophagus; Li, lingula segment of the left upper lobe;
LLL, left lower lobe; lul, left upper lobe bronchus; LUL, left upper lobe; MF, major fissure;
RLL, right lower lobe; RML, right middle lobe; rml, right middle lobe bronchus; RUL, right
upper lobe; rul, right upper lobe bronchus; ss, bronchus to superior segment of lower lobe;
t, trachea.
• Menurut Lynne Reyd dibagi menjadi 3 bentuk berdasarkan pelebaran bronkus dan derajat
obstruksi, sebagai berikut :
• 1.Bentuk silindris (tubular) 2.Bentuk varikosa (fusiform) 3.Bentuk Kistik (sakuler)
Tubular Shadow
Merupakan bayangan
yang putih dan tebal.
Lebarnya dapat
mencapai 8 mm.
Menunjukkan
bronkus yang penuh
dengan sekret.
Glove Finger Shadow
bayangan
sekelompok tubulus
yang terlihat seperti
jari-jari pada sarung
tangan.
Tramline shadow
Bayangan ini terlihat
terdiri atas dua garis
paralel yang putih dan
tebal yang dipisahkan
oleh daerah berwarna
hitam.
 “Tram tracks” on the routine chest
radiograph in bronchiectasis

A, In the right lower lobe are parallel, nontapering shadows,

“tram tracks” ( arrow ) , representing bronchiectasis.
B, The airway is seen as cylindrical bronchiectasis ( arrow ) .
 Ring Shadow
Terdapat bayangan seperti
cincin dengan berbagai
ukuran (dapat mencapai
diameter 1 cm) dengan
jumlah satu atau lebih
bayangan cincin sehingga
membentuk gambaran
‘honeycomb appearance’
atau ‘bounches of grapes’.
 Varikoce
Bentuk antara bentuk
tabung dan kantong
 Axial CT image
demonstrates the “signet
ring” sign (arrow) of
bronchiectasis created
by the dilated bronchus
(the ring) and adjacent
artery.
Multiple ring shadows on chest
radiography in bronchiectasis
Cylindrical (A) Fusiform (B) Saccular (C)
 BRONCHIECTASIS: KARTAGENER SYNDROME.

A, Frontal chest radiograph shows dextrocardia with basal predominant

linear opacities, the latter consistent with bronchial wall thickening and
bronchiectasis.
B, Axial chest CT shows dextrocardia and severe, cystic bronchiectasis.
Numerous small nodules are consistent with small airway impaction.

(Courtesy Michael Gotway, MD.)

CONGENITAL TRACHEOBRONCHOMEGALY (MOUNIER-KUHN
SYNDROME) WITH BRONCHIECTASIS.
A, On the
posteroanterior view, a
massively dilated trachea
( arrow ) is seen.

B, The dilated trachea

with prominent
cartilaginous rings is
confirmed on a CT scan
( between arrows ).

C, Not only is the trachea

enlarged, but the main-
stem bronchi are dilated
( between arrows ).
WILLIAMS-CAMPBELL SYNDROME

This 50-year-old man had a

lifelong history of recurring
respiratory infections and
productive cough. The
airways are massively dilated
with collections of respiratory
secretions pooling in some of
the cystic spaces. Notable are
the normal dimensions of the
main-stem bronchi ( between
arrows).
 BRONCHIECTASIS: WILLIAMS-CAMPBELL
SYNDROME.

Frontal ( A ) and lateral ( B ) chest radiographs show

bilateral linear and reticular opacities ( arrows )
representing the walls of severely dilated
bronchi. C, Axial chest CT following left lung
transplantation shows severe cystic bronchiectasis
( arrows ) in the native right lung.
 BRONCHIECTASIS: ALLERGIC
BRONCHOPULMONARY ASPERGILLOSIS

A and B, Axial chest CT shows central

bronchiectasis ( arrows ), typical of allergic
bronchopulmonary aspergillosis.
 BRONCHIECTASIS: COMMON VARIABLE
IMMUNODEFICIENCY

A–C, Axial chest CT displayed in lung windows shows

multifocal areas of reticulation reflecting scarring
from recurrent inflammatory episodes.
Bronchiectasis ( arrowheads ) is best visualized in
the right middle lobe.
 BRONCHIECTASIS: ALPHA 1 -ANTIPROTEASE
DEFICIENCY.

A and B, Axial chest CT in a patient with panlobular

emphysema due to alpha 1 -antiprotease deficiency
shows mild bilateral lower lobe bronchiectasis
( arrows ).
BRONCHIECTASIS: SARCOIDOSIS

A and B, Axial chest CT

through the upper lobes in
a patient with sarcoidosis
shows biapical
bronchiectasis with
architectural distortion, the
latter consistent with
fibrosis.
BRONCHIECTASIS: ANKYLOSING SPONDYLITIS

A and B, Axial chest

CT shows lingular
bronchiectasis
( arrowheads ).
 Relapsing polychondritis.

• A, Axial inspiratory chest CT shows thickening of the anterior

two thirds of the trachea ( arrowheads ). A tiny focus of
calcification is present within the thickened trachea at the 1
o'clock position. B, Axial chest CT performed following a
forced vital capacity maneuver shows excessive trachea
collapse ( arrowheads ), consistent with airway malacia. The
constellation of findings is typical of relapsing polychondritis.
(Courtesy Michael Gotway, MD.)
• The goals of treatment are to improve clearance of
tracheobronchial secretions, control infection, reverse
airflow obstruction, and prevent complications
• Pharmacotherapy includes antibiotic medications to
prevent and treat recurrent infection, anti-
inflammatory agents, mucolytic agents, and inhaled
bronchodilators. Chest physiotherapy may help
remove copious sputum. Surgery may be considered
in patients with localized disease
• Bronchiectasis is increasingly recognized as an
important cause of respiratory morbidity worldwide.
The mortality rate of bronchiectasis is reported to be
13%
FIBROSIS KISTIK
 BRONKITIS
Tampak corakan
bronchovascular
yang prominent
dan gambaran
tramline.
 Variable Bronchiectasis COPD Asthma
Age of presentation 45 to 65 years Older than 60 years 2 to 20 years; older than 40 years

Sex bias Female Male None

Cause Infection, genetic or immune defect Cigarette smoking Family history of allergic disease;
idiosyncratic, usually after an upper
respiratory infection

Role of infection Primary Secondary Exacerbations

Predominant organism(s)
Airflow obstruction and hyper-
responsiveness
H influenzae,P aeruginosa S pneumoniae,H influenzae Viruses such as respiratory syncytial
virus, parainfluenza virus,
rhinovirus, influenza virus
Present Present Present

Pulmonary function test findings Fixed and reversible obstructive airflow
limitation
Chest imaging findings Airway dilatation and thickening (ring
shadow), mucus plugs, nontapering
bronchi (tramlines), atelectasis, focal
pneumonia
Quality of sputum (in the steady Purulent, three-layered
state)
Predominantly fixed airflow Predominantly reversible airflow
obstruction, decreased DLCO, obstruction, normal DLCO
increased RV and FRC*
Hyperlucency, hyperinflation, airway Hyperinflation
dilatation, bronchial thickening
Mucoid, clear Rare

Symptoms Productive cough, dyspnea Chronic productive cough, dyspnea Episodic cough, dyspnea

Signs Crackles Hyperexpansion, prolonged None/wheeze

expiration