Differentials
COPD
SIGNS / SYMPTOMS
Diminished breath sounds, characterising COPD, are not found in bronchiectasis.
In bronchiectasis, rhonchi may be auscultated, but with additional inspiratory squeaks and crackles.
INVESTIGATIONS
Chest CT may be normal or show emphysema in COPD, as opposed to the characteristic abnormal results found in bronchiectasis (thickened, dilated airways with or without air fluid levels, varicose constrictions along airways, ballooned cysts at the end of a bronchus, and/or tree-in-bud pattern). Patients with COPD may also develop bronchiectasis.
Asthma
SIGNS / SYMPTOMS
Inspiratory squeaks and crackles, often present in bronchiectasis, are not present in asthma.
INVESTIGATIONS
Chest CT may show thickened airways but lack the enlarged or widened airway (signet ring sign) seen in bronchiectasis (thickened, dilated airways with or without air fluid levels, varicose constrictions along airways, ballooned cysts at the end of a bronchus, or tree-in-bud pattern).
Airflow obstruction is often reversible in asthma.
Patients with asthma may also develop bronchiectasis, particularly those with severe asthma.
Pneumonia
SIGNS / SYMPTOMS
Patients with pneumonia describe symptoms of short duration (7 to 10 days), as opposed to years in bronchiectasis.
Auscultation findings (rhonchi, wheezing, crackles) may be similar in bronchiectasis and pneumonia, especially multi-lobar pneumonia. Bronchial breath sounds, which are characteristic of pneumonia, are not present in bronchiectasis.
INVESTIGATIONS
CXR and chest CT results in pneumonia are quite variable and often depend on aetiology.
In bronchiectasis, there is characteristic dilation of bronchi with or without airway thickening.
Consolidation, which is seen in pneumonia, is not seen in bronchiectasis.
Chronic sinusitis
SIGNS / SYMPTOMS
The inspiratory squeaks and crackles found in bronchiectasis are uncommon in chronic sinusitis.
INVESTIGATIONS
CXR and chest CT are normal in chronic sinusitis. Sinus CT shows opacification of the involved facial sinus in chronic sinusitis.
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