Category | Specific examples | Key diagnostic clues (in addition to a general evaluation)* |
Postinfectious conditions | ||
Protracted bacterial bronchitis |
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Specific pathogens |
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Severe, chronic, or recurrent bacterial pneumonia |
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Postinfectious bronchiolitis obliterans including unilateral hyperlucent lung (Swyer-James syndrome) |
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Bronchial narrowing/obstruction | ||
Congenital abnormalities |
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Foreign body aspiration |
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Endobronchial obstruction |
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Hilar adenopathy |
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External airway compression |
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Immunodeficiencies | ||
Immunoglobulin deficiencies |
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Combined immunodeficiencies |
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Leukocyte dysfunction |
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Complement deficiency |
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Acquired immunodeficiencies |
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Primary impaired mucociliary clearance | ||
Abnormal secretions |
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Ciliary dysfunction |
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Unknown mechanism |
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Miscellaneous disorders | ||
Aspiration (recurrent, small volume) |
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Ineffective cough with impaired mucus clearance |
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Systemic autoimmune or inflammatory disorders, or interstitial lung disease |
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Bronchiolitis obliterans |
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Environmental exposures (inhalation of toxic fumes and dusts) |
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Genetic syndromes |
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CT: computed tomography; PCR: polymerase chain reaction; CPAM: congenital pulmonary airway malformation; CCAM: congenital cystic adenomatoid malformation; IgE: immunoglobulin E; BAL: bronchoalveolar lavage; MHC: major histocompatibility complex; WHIM: warts, hypogammaglobulinemia, infections, and myelokathexis; NK: natural killer; NADPH: nicotinamide adenine dinucleotide phosphate; DHR: dihydrorhodamine 123; THC: total hemolytic complement (CH50); HIV: human immunodeficiency virus; CFTR: cystic fibrosis transmembrane conductance regulator; GERD: gastroesophageal reflux disease; CNS: central nervous system; PFT: pulmonary function test.
* The general evaluation for bronchiectasis includes a focused history, PFTs (if the child is able), and chest imaging (typically chest radiograph and chest multidetector CT). These steps document bronchiectasis, assess its severity, and may help to identify the specific cause. Additional key diagnostic steps are noted for each category.
¶ If antibody titers are low, administer vaccines and repeat the titers to evaluate the response. Refer to UpToDate content on evaluation of children with recurrent infections.
Δ Although GERD is associated with a modest increase in bronchiectasis risk, its role as a primary cause in children without other risk factors is questionable. If GERD is strongly suspected, the evaluation may include esophageal pH and impedance monitoring and upper gastrointestinal endoscopy. Refer to UpToDate content on evaluation of GERD in children.
◊ Several types of diffuse/interstitial lung disease in children can be complicated by bronchiectasis (often traction bronchiectasis), with or without the histologic finding of bronchiolitis obliterans. Refer to UpToDate content on diffuse/interstitial lung disease in children.
§ Pulmonary manifestations of alpha-1 antitrypsin deficiency (emphysema and/or bronchiectasis) generally do not present until mid-adulthood.Do you want to add Medilib to your home screen?