LOCALIZED BRONCHIECTASIS SIMULATING PULMONARY NEOPLASMS

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Abstract
Bronchiectasis may be a localized disease involving a single lung segment or subsegment. Clinical differentiation between acquired bronchiectasis and congenital bronchogenic cysts, although well defined in most cases, may become tenuous when the bronchial ectasia is well circumscribed and all signs of infection have abated. An area of localized bronchiectasis may not cast a roentgen shadow. Existence of underlying pulmonary disease may be suggested in time following repeated exacerbations of respiratory tract infections. However, a definitive diagnosis will be established only if a bronchography is performed. When the bronchial sacs become filled with fluid and surrounded by zones of pneumonitis they will be visualized as localized, rounded shadows on the usual chest films. In those patients who manifest symptoms and signs of a febrile illness this pulmonary involvement may be attributed to a lung abscess or to a localized area of bacterial or viral pneumonia. When the mass is located in an upper lobe it may also simulate pulmonary tuberculosis roentgenologically. At other times, however, these pulmonary nodules may be detected initially on routine chest roentgenograms in apparently well persons. In such cases the circumscribed pulmonary lesions must be differentiated from tuberculomas, localized fungus infections of the lungs, such as histoplasmosis and coccidioidomycosis, and from pulmonary neoplasms. Bronchography may reveal graphically that some pulmonary "coin" lesions noted on ordinary chest films are manifestations of localized brochiectasis. This simple procedure will then clarify the diagnosis and indicate the required treatment.

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