Bronchiectasis is generally defined as an abnormal and permanent dilatation of the cartilage-containing airways. It is recognized more frequently now because of the widespread use of high-resolution computed tomography (HRCT) scanning. Bronchial dilatation is generally regarded as irreversible in adults. In contrast, children may have resolution or significant improvement in airway wall thickening and bronchial dilatation on repeat CT, demonstrating the potential for reversibility of the condition.1 There have been isolated case reports2–4 of reversal of bronchial dilatation in adults demonstrated by bronchography; however, we found no such reports in over 50 years, and therefore to our knowledge, this phenomenon has not been previously demonstrated using CT scanning.
A 68-year-old woman presented to the University of Connecticut Center for Bronchiectasis Care with a 5-month history of persistent productive cough, nasal congestion, and shortness of breath that had been unresponsive to antibiotics, inhaled corticosteroids, and bronchodilators. She was a nonsmoker with no significant environmental exposures. A physical examination showed evidence of mild rhinitis, good air entry, crackles at both bases, and no wheezing or prolonged expiratory phase. Spirometry showed no evidence of obstruction. A chest radiograph demonstrated a crescent-shaped density in the left lingula. HRCT (Figs. 1A, C) showed diffuse bronchiectasis, with bronchiolitis of the right middle lobe, the lingula, and the left lung base. A diagnostic workup did not reveal an underlying cause of bronchiectasis, and bacterial, fungal, and mycobacterial cultures were negative. She was treated with only a mucus clearance regimen and noted gradual improvement of her symptoms. A follow-up HRCT 11 months later (Figs. 1B, D) showed almost complete resolution of the bronchial dilatation, with near-complete resolution of terminal bronchiolitis.
Bronchiectasis is a result of inflammatory and infectious damage to the bronchiolar and bronchial walls leading to a vicious cycle of airway injury. An initial or chronic insult to the respiratory tract causes impaired mucociliary clearance, leading to secretion stasis and infection, causing additional damage to the bronchial wall, and eventually resulting in bronchial dilatation. There are enhanced cellular and mediator responses, although their roles are poorly understood. Although reversible bronchial dilatation as a sequelae of pneumonia or atelectasis has been demonstrated in adults using bronchography in the 1950s and 1960s,2–5 to our knowledge, no subsequent cases in adults have been reported, and therefore, this phenomenon has not been demonstrated with HRCT.
In the majority of patients with bronchial dilatation, the dilatation represents the sequelae of chronic airway inflammation and is permanent, reflecting the presence of bronchiectasis. This case demonstrates that, although quite rare in adults, spontaneous resolution may occur. Therefore, the diagnosis of bronchiectasis should be made with caution in patients with symptoms that have lasted for months, as opposed to years. In a patient with bronchial dilatation and symptoms suggesting bronchiectasis whose condition improves, with or without therapy, the possibility of resolution should be considered. In such a patient who might otherwise be considered as merely responding well to the therapy, demonstration of radiographic resolution might prevent the burden and cost of continued therapy.
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