History: 65 year old male with shortness of breath.
This is the appearance of bronchiectasis. Bronchiectasis is defined as abnormal widening or dilatation of the airways. It can be diagnosed by a bronchoarterial ratio (B/A) of greater than 1.5. Other ways to diagnose bronchiectasis include lack of bronchial tapering after airway bifurcations and visualization of the airways within 1 cm of the costal pleura.
Bronchiectasis has many forms, including cylindrical with uniform dilatation, saccular which typically appears as a “cluster of grapes”, varicose (seen in the image above), and cystic (seen in the image below).
The differential diagnosis of bronchiectasis includes post-infectious etiologies such as mycobacterium tuberculosis, mycobacterial avium complex, Swyer-James syndrome, and aspiration, as well as post-obstructive causes such as endobronchial tumors and foreign bodies, traction bronchiectasis seen in interstitial lung disease, cystic fibrosis, asthma, allergic bronchopulmonary aspergillosis, and immotile cilia syndrome (Kartagener syndrome).