The

Problem

of
A

BERNARD

Bronchiectasis,

like

bronchiectasis,

schedule.
if given

of

few

bronchiectatic

ever

able

the

to

unless
we

in

economic

tendency

more
of

live

who

far
is

to

to
had

heal
far

regained

but

we

disease
dependent

progress

men;

definite

tends
once

have

advanced

of

fairly

state,
who

a miserable,

bronchiectasis

found,
in a group
had
acquired
their
were
living
after

independence;

with

than

a killer

on

a terminal
many
people

see

patients
do

is
kills

tuberculosis,

and

F.C.C.P.

tuberculosis,

tuberculosis,

pulmonary

health

F.A.C.P.,

California

pulmonary

and

active

measure

M.D.,

Hollywood,

unlike

Tuberculosis,
chance;

advanced

Review

E. McGOVERN,
North

but

Bronchiectasis*

see

very

who

are

existance;

downward.

Head

of two
hundred
bronchiectatic
patients,
who
disease
in the
first
ten
years
of life,
that
few
forty
years
of age.
Riggins,2
from
observations

at the Bellevue
with
Head
for

and
the

Lennox
Hill Hospitals,
most
part;
but
also

bronchiectatic

patients

in

their

sixth

New
a

saw
or

York
City,
agreed
fair
sprinkling
of

seventh

decades.

While

Roles
and
forty-nine
six years.

Todd
observed
a forty-seven
non-surgically
treated
patients
Clagett
and
Deterling,
Jr.,4 stated

per
cent
mortality
that
were
followed
that
some
bronchiec-

in
for

tasis

found

necropsied

was

in

Mayo
The

Clinic.
bronchiectasis

upper

portion

stenosis,

bronchiectatic

and

lingula

as

the

left

of

bronchitis,
as

the

virus
from

in

the

the

upper

which

increase

type

of

to

and

lobe

is

the

uphill,

which

the Glendale
at Glendale,

pull

a tendency
Branch
California,

Downloaded From: http://journal.publications.chestnet.org/ on 11/14/2014

the

various

the

toward

its
with

in-

middle
more

follows

is

lobe,
liable

more

hilar
cases

tendency
areas

to

or less
infections

enlarged
these

pleural

the

to trap
of atelecspace;

recovery

of The Los Angeles

October
20, 1947.
208

in

tuberculosis),
the
drainage

and

in

of

and

bronchial

may
be a
respiratory

tuberculosis;

negative
has

the

lobe

right

bronchial
stenosis
with
its egress,
combined

bronchiectasis

at

following

lobes,

there
acute

cases

atelectasis,

(including
is downhill;

and

phase

upper

due

lower

Also,
following

pneumonia,

tasis

right

tissue

course.

follows
and
prevent

the

the
lung
the
drainage
in

primary

all

scar
of

left

bronchiectasis
inspired
air

*Read
before
Association,

of

lobe

lesions

a progressive
bronchiectasis

glands

cent

upper

contracting

conditions
benign
because

of

pursue
temporary

per
found

of

and

flammatory
relatively

two

County

this

when

the

Medical

Volume

XV

THE

causative
do

conditions

not
become
Bronchiectasis,

dilatation
or

PROBLEM

lung

the

units

further

are

grossly
as

of

the

the

anlage

of

the

the
it,
and

larynx,

as

the

laryngotracheal

and

it

becomes
and
becomes

separated

portion
the

becoming
trachea56

cephalic
becoming
bud,
lung

becomes
bibbed
buds
elongate,

at first.
downward,
give

rise

to

the

In

the

is
seven

bronchial
right

upper

lobe

lobe

bronchus
chial
future

stems
bronchi
before

cartilage
tracheal

the

left

buds
Into

plates,
muscle,
and
bronchial

developing
visceral

mass.
pleura,

the

parletal

pleura.
forms

the

also

lower

the
sixth
place.56

month;

and

the

cells

the

bronchiole,

Downloaded From: http://journal.publications.chestnet.org/ on 11/14/2014

lung

or
is

alveoli
fully

merely

the

smaller

right

on

the

left

main

bron-

bronchi.56
cells
and

carry-

the
nerves

These

forms

the

lungs,
grow

and
into

mesoderm
mesoderm
primitive

these

the

to

form

formed

forms
forms

trachea

and

begin

when
tree

conduit

two
future

future

the

of

tracheo-bronchial
as

the
arises

and

the
of

develop-

mesenchyme

of
lining

to

of

bud,

lobe

tissue
vessels

grow

bronchi,

mesenchymal

The
air

Both
left

the

apical

bronchus);

The

entoderm

part
lung

the

stem

bud,

bud

connective
Blood

epithelium

considers

ventral

lobe

of

the

(splanchnic)
(parletal)

The

Macklin7

of
the

embryos.
than

stages

(the

The
visceral
and
the
somatic

units.56

respiratory

from

ventral

walls.

arises

outgrowth

intermediate
portion,

later

side

mesoderm.

lung

the

the

right

upper

of

lungs

this

branching

become
the
a mass
of

folds

them

lungs

main
bronchial
stems)
branching
monopodlally

In

and
a

and

oesophagus,

and
the
caudad

embryo,
on

grow

of

primitive

dichotomous

future

this
the
bronchi

bronchi.

bronchus;

or

the

(stem
buds,
backward,

bronchus);

(the

end

to five
millimeter
being
slightly
larger

probably

arise

caudal

four
right

millimeter

buds

middle

future

develop-

tree

and

The

and

treatment
the

segments;
3.2 mm.
in
wall
of the
entodermal
This
anlage
is known

larynx
rounded,

buds

going

marks
the
future
development
of the groove
proceeds
cephalad

from

the

lobules

and
review

bronchi,

The

the
in

These
lung
lateralward

ment
there
bronchi.56

ing

groove.
rounded
and
lungs;
constriction

acquired

before

tracheo-bronchial
be better
understood.

trachea,

an

But

to briefly

walls

primary

pathology,

advisable
of the
may

is

the

parenchyma.

about
the
fifteenth
day
(embryo
of 23
length)
from
an outgrowth
in the ventral
tube
(the
foregut;
the primitive
oesophagus).
promptly
the bronchi

bronchial

understand

bronchioles

pathogenesis,

it seems

and
final
anatomy
that
these
phases

The

provided

pulmonary

etiology,

of bronchiectasis,
mental
in order

removed,

and

209

BRONCHIECTASIS

infected.
we ordinarily

bronchi
of

into

OF

system;

and

lining
at

of
about

birth
as

far
while

takes
as

the
the

BERNARD

210
part

beginning

the

with

pulmonary

they
enter
a circular
tunica

the
layer

propria.

inent

as

the

alveoli

the

respiratory
is

the

fibers

bronchi

are

as far
(cartilage,

as

the
atria.6
The
white
fibrous

other
tissue,

crease

as

the

is best
strong

developed
sphincteric

smaller,
the
and
disappear
The

bronchi
in the
action

mucus

glands

also

ciliated,

bronchi;

columnar,
when
the

as

ciliated
respiratory

rings
of

bronchi

are

epithelium;

(Fig.

change
about

then
is

areas
portion

prom-

to

extend

(Fig.

lines

the

muscle

can
exert
a
bronchi
grow
or flakes,
diameter.6
1).
trachea

ciliated
reached,

cuboidal
epithelium;
the
epithelium

squamous
the
tract

probably

becomes

and

this

or
(alveoli,
deficient8

simple,

in

FIG.I

8------

IJU

I
\ii

Diagram

of origin

of lungs

and

bronchi.

1, Entodermal
tube
(fore-gut);
2, primitive
trachea;
3, lung
bud
from ventral
aspect
of entodermal
tube;
4, mesenchyme;
5, mesothelium
(visceral),
future
visceral
pleura;
6, primitive
esophagus
from
fore-gut;
7, ventral
bud (future
left upper
lobe bronchus);
8, stem
buds
(main
bronchial
stems);
9, ventral
bud
(future
middel
lobe
bronchus);
10, apical
bud (future
right
upper
lobe bronchus).
On left
side, apical
bud in ventral
bud; no separate
lobe on left side comparable to right upper
lobe; 11, septum
transversum
(future
diaphragm).

Downloaded From: http://journal.publications.chestnet.org/ on 11/14/2014

be-

respiratory
air cells)

2).

4/

wall
de-

smaller,

of
of

more

small
plates
millimeter

here6

acquire
of the

circular
and
the

as

with
when

bronchial
glands,
etc.)

The

to
one

about

ending

found

the

1949

bronchi,

and

are

of
tissue,

reached.

grow

epithelium;
bronchiole

squamous

and

elements
elastic

epithelium

with

with

more

reached,

disappear

comes
simple
cuboidal
epithelium.
The
remaining
lined

The

and
gradually
outer
border

the

become

are

columnar
the

and

part.

terminal
bronchiole,
in bronchospasm;8

cartilagenous
in
bronchi

Stratified,
larger

smaller

bronchiole

cylindrical
muscle
on

muscle

smaller

February.

functional

lungs,
become
of smooth
These

E. McGOVERN

places

xv

Volume

Millers2
chiolus

lung

rise

unit

begins

with

the

respiratory

which

gives

off

several

alveolar

to

several

atrium
dibula;

passages;

irregularly

originates
air
sacs);

number

of

and

(0.3
0.4
piratory

alveolar

alveolar

sac

(0.3

after
a

meters

in

approach
maintain

and

mm.)

from
origin

of

Taylors8
with
the
terminal

and

arise
gives

each
infunarise

begins
of the

0.5

gives

atria;

diameter
one
resto three

rebranchings;

an

pouches,

the

As

of the
diameter

lung,
as

being

about

small

periphery
the
same

first

the

Best

number
of

about

(ductili
duct

alveolaris;
wall,
there

cells).

ducts
duct

a variable

the

parts,

(0.2

alveolar
alveolar

number

ducts

primary
lobule
a continuation

length

six
an

(bron-

alveolar

(sacculi
sac

air

is

the

mm.),

sacs
alveolar

or

same

or
and

sacs

0.4

the

five

each
dilated

pulmonis;
unit
which

contains

the
bronchioles
shorter,
but
ones

has

mm.);
bronchiole;

six

(alveoli

bronchiole
alveolar

vestibules);

alveolar
in each

of a lung
bronchiole,

bronchiole,

BRONCHIECTASIS

spherical

several
and

alveoli

description
respiratory

to

PROBLEM

respiratorius)

alveolaris;

OF

211

THE

branches

alveoli.

they
grow
the
earlier
1.5

milli-

length.8

FIG. 2.

10

,.:...

5-J

_L.

----

Diagram

(
/

of cross

.1-i .

(__

section

of medium-sized,

,,

/,

intrapulmonary

_7-___

13

bronchus.

1, Stratified,
ciliated,
columnar
epithelium;
2, basement
membrane
(membrana
propria);
3, goblet,
mucus
cell; 4, outer
layer of tunica
propria,
shows longitudinal
elastic
fibers
cut across,
and white
fibrous
tissue,
inner
layer
shows
fine, loose
fibers
and basement
membrane;
5, racemose
mucus
and serous
gland
opening
on
mucus
surface
and
extending
Into
adventitla;
6, mucus
membrane;
7, tunica
propria
(corluxn);
8, lymph gland; 9, 10, 12, blood vessels.
All layers
contain
blood
vessels,
nerves,
lymphatlcs
and secreting
glands;
11, hyallne
cartilage
plate in
dense fibro-elastic
layer;
13. fat cells;
14, submucosa
of coarse,
loose areolar
tissue
with glands,
vessels,
nerves
and lymphatics;
15, adventia
of loose areolar
tissue
with
glands, vessels,
nerves
and lymphatics;
16, fibro-elastlc
layer of white
fibrous
tissue
and
yellow
elastic
fibers densely
arranged;
17, circular,
smooth
muscle

layer

in mucus

membrane.

Downloaded From: http://journal.publications.chestnet.org/ on 11/14/2014

212

BERNARD

The
be

essential

etiology

summed

tained

up

infective

with

of

and
permit
with
the

dilate

the

walls

or potential
surrounding
tissue

in

the

air

check-valve
dilating
The
irregularly
in

elements
pull
pooled

bronchi

are

but

which

in

with

Its

bronchiectasis
because

that

follows

with

possible
one

more

of

the

this

also
exert

of

developing

the

of

the

some

upper
chronic

greatly

well

known

of

which

the

tuberculosis

air,

the
the

produces

Even

fibrosis
downhill;

bronchial

is

by

by

ordinary
of

so,

this

upper

usually
relatively
the
bronchiectasis

but

walls

complications

can
during

is

bronchi

walls
is heightened.
lobes,
caused
by

fibrosis.3

infection

surgical

Bronchiectasis
of cases
develop

of the
fibrous

gnarled
bronchi
which
does
not present
in ordinary
lower
lobe
bronchiectasis

of tubercubous
drainage
is

severer

permanent

portions
inelastic,

Jacksons
of

and

possibly
gradually
to

pull

Chevalier

rewalls,

tissue

into
of

occluded

egress

fibrosis

elastic

inspiratory

partly

can
with

bronchial

units

lung,

evenly

require

lung

infection-weakened
mainly
in the

secondary

as

is atelectasis
is contracting,

preventing

the

invasion

may

and

the

of inspiration,
secretions,

there
there

1949

bronchiectasis
a bronchus

of

rythmical
of the

the distorted,
pattern
seen

lobe
benign

infection

stromal

developing

dIlatation
the
regular

of

the
weight

there

action
effect
on
bronchiectasis,

of

Stenosis

such

surrounding

February,

pathogenesis

permit

the

to enter,

McGOVERN

words:

When
or when

when

permit

and

of

cavities.
lung;

Increased;

and

a few

secretions

weakening

muscle,
combined

is

in

E.

tubercle

bacilli,

pyogenic

pulmonary

bacteria,
tuberculosis,

removal.

develop
at any
age;
the first
ten years

but
a large
of life. Perry

percentage
and
King4

claimed
that
the onset
of 42 per cent
of their
patients
was during
the
first
ten
years,
and
that
the
onset
occurred
in 27 per
cent
during
the
second
ten
years.
Farrell5
stated
that
80 per
cent
of
his

bronchiectatic

ten

years.

Singer
shadows

and
seen

dlaphragmatic

acquired

Graham6
along
the

pointed
mediastinal

leaflets,

peripherally
seen
but

patients

were

principally
larger
and

interstitial
McNeil,

apices

due

to

in infants
less
dense

infiltration
MacGregor

their
out

in

disease

that
borders

the

hill,

atelectasis

of

children.
shadows

and
fibrosis
and
Alexander,17

in

the

and

and
young
triangular

during

the

dense,
triangular
with
bases
on
hypotenuses

lower

lobes.
There
which

bronchiectasis.
Richards,18

and

These
are
are

Anspach,9

infants

and

children

thick,

tenacious

secretions

Downloaded From: http://journal.publications.chestnet.org/ on 11/14/2014

with

susceptible
attendant

are

similar,
due
to

these
triangular
areas
of atelectasis
frequently
pneumonia,
were
often
followed
by bronchiectasis
In infants
and
children.
The
smaller
bronchi
especially

the

facing

showed
that
companying
later,
especially

are

first

to

plugging,

atelectasis.

It

acof
from

is a law

Volume

of

XV

the

THE

cube

greater

that

surface

PROBLEM

the
for

OF

smaller

adherence

213

BRONCHIECTASIS

bronchi

would

per

of

unit

present

volume

than

relatively
the

larger

bronchi.
Anything

which

chiectasis.

lung

infections,
stenosis
of
The
inhalation

beyond

particularly
long
age

ago,

the

the

obstruction

in

children;
and

is

curring

in

of

of

exocrine

fats

and

other

of vitamines
infection
of

bronchi
of foreign
are

body
of

the

Chevalier

than

constituents

and
D
respiratory

and

pointed

the

metallic

of

the

with

pancreas.
failure

lack
these

The
to

of

pyogenic

depicting

William

S. Millers

1, atria;
4, respiratory

2, alveolar
sacs (infundibuli);
bronchiole;
5, terminal

7, pulmonary
a branch
alveoli;
8,

arteriole
to
each
pulmonary

partly

independent

primary

lobule

3, alveolar

permit
espec-

or lung

ducts

unit.

(vestibuli);

alveoli (air-cells);
terminal
bronchiole,
and giving
forming
capillary
plexuses
around
bronchiole;

accompanying
atrium;
then
venule
collecting

course

Downloaded From: http://journal.publications.chestnet.org/ on 11/14/2014

back

to heart,

6,

from

plexuses;

but

joining

then

other

digest

absorption

in turn
organisms,

Diagram

one.
oc-

F1G.3

8--i

out

to encour-

bronchiectasis

causes

malnutrition;
tract
with

glands
of brondrowned

the

liable

and

pancreas

childacute

of bronchiectasis,

is more

fibrosis

the

these

Jackson

peanut

cystic
of

nutritional

sources

bronchitis

having

of

bron-

measles,

sources
in
following

adenitis

suppuration

chronic

secretion
A

as

to

cough,

with
development
bodies
with

frequent

as the

pulmonary

form

children

lack

tuberculous

the

predisposes

whooping

are
special
hilar
glands

and

and

and

vegetable

bronchial
There

stenosis

bronchi

and
bronchitis,
tracheobronchial

chronic

may
cause
chiectasis.

bronchial

inflamed

bronchopneumonia,
hood;
enlarged
and

causes

The

following
venules.

214

BERNARD

ially

staphylococci;

is

piling

trachea

as

up
and

of

is

with

found

congenital.

Mayo
tasis

He

cent

of
as
of

tasis,

because

in

bronchi

as

fibrotic

and

involvement

retained

atelectasis
into

all

the

the

here

allergy

Kibler23

the

bronchial

of

is

furnish

of

of

allergy

bronchiectasis;
The
pathological

vasion

of

the

pathogenic
lowed
by
inelastic,
and
of
older.

bronchial

white

gelatinous,
retained
There

fibrous

but
of

the

Downloaded From: http://journal.publications.chestnet.org/ on 11/14/2014

becomes
elastic

Uncombronchiec-

their

and
an

hemorrhagic
damaged

scattered

areas

bacterial

of

pathogens

tissues.
earlier

its

theory

of

attendant
most

The
by

the

of
and

scar

hard

development

the

the
blood
replacement

is

folby

when

young

the

weight

contracted
the

so.
in-

by

and

and

does
The

tissue

tissue,

in

sten-

cause
of
and
muscle

that
varied.

lung

inspiration

elements

that

bronchial

for

cells

theirs

frequent
swelling

surrounding

white
destruction

tissue.

tu-

bronchial

frequently
Here,
there
is
and
peribron-

the
only
mechanism
bronchiectasis
are

stretched

the

and

foundation

and

defence
of
scar

easily

secretions;
Is loss

in
walls

and
degrees
is

not

empy-

are

the

was
the
the
bronchial

a good

but
is
changes

bacteria
varying

with

secretions
true
that

or

parenchymal

secondary
an

fibrosis

pleural

with

surrounding

tubes

spasm

of

and

of

gases,

on

exudate
bronchi

of

of

corrosive

bronchiectasis.
rarely
causes

secretions,

invasion
reiterated

osis
and
retention
bronchiectasis.
It

pressing
of

pairs
theory

of bronchiectasis.
extrabronchial

is primarily

an
alveolar
occluded

walls

and

causes

types
of pneumonia
of bronchiectasis.
of the
bronchial

infective

favor

bronchial

Watson

that

bands

development
lobar
pneumonia

as well
as
The
partly

congenital

causative
tumors;

the

registered
in

bronchitis,
be

this

at

of bronchieccontrast
to less

patients

the

of

seen

pneumonoconiosis,

the like, may

intrabronchial
the

cases

occurring

and

lungs

or

the

five

other

bronchopneumonia,

encourage
pneumococcus

chial
tissues
pneumonitis.

all

as-

Kartagener
bronchiectasis

that

evidence
cases
in

for

not
bronchial.
But
the
virus
followed
by the
development
intense
inflamatory
involvement

walls

ducts,

frequently
the

dextrocardia

inclusive;
of these

evidence

both

glands,

all

of

bronchiectasis

the
or

infections,

large

cases

to 1941,
per cent

further

ema,
lung
abscess
and
Benign
or malignant
walls
plicated

there

gland

sinusitis

reported

bronchiectasis

stenosis

mors;

85

mentioned

identical
twins
bronchiectasis.
Any
condition
fungus

salivary

inversus,
theory

Churchill2

reviewed

also

bronchial

1949

A deficiencies,

the

situs
of the

support

Clinic
from
1920
was
found
in 16.5
1 per

in
and

and

and

Olsen22

there.

February,

vitamine

debris

bronchiectasis

Adams

than

other

epithelial

with
dextrocardia
He cited
this
in

syndrome.

McGOVERN

bronchi.

Kartagener2#{176}
sociated
triad.

E.

bronchial

when
walls.

220

BERNARD

torlas;

el

crOnica;

tratamiento
el

de

las

extraflos
extrinsecos;
o extrabronquiales
hlpertroflados;
el
o

los

las

higiene

ocasionalmente
superior
poder

no
de

es el riesgo

y la

extracciOn

tonsilitis;
de

buena
no

avanzada

ha avanzado
lobectomia,
El
y

subaguda
y

ocasionalmente,

neumonectomla.
regenerativo

y fisiologicas

la

1949

el
cuerpos

de tumores
endobronqulales
tr#{225}queobronquiales
e hiliares
tales
como
las sulfonamidas

general

u,

paciente
consiste

bronquitis
senositls

respiratorias;

c#{225}lldoy seco.
de la bronquiectasla
el

February,

la
de

el tratamiento
y de
ganglios
empleo
de drogas,
la

qulr#{252}rgico,
si
Este
tratamiento

la

alergias

(autOgenas

un clima
tratamiento

de

oportuno

antibiOticos;
vacunas

veces,
El

oportuno

tratamiento

tratamiento

E. McGOVERN

sus

quirUrgico

alimentaciOn;
autOgenas)

y,

es principalmente

a un
resecciOn

estado
terminal.
segmentaria

paciente
mayores

m#{225}sjoven,
con
reservas
anatOmicas

preferido

en

operaciones

y,
su

para

bronqulectasia.
REFERENCES
1

Head,
J. R.; quoted
by Riggins,
ogenesls,
Morbidity,
Mortality,
Dis. of Chest,
9:5, 1943.

2 Riggins,

3
4
5

6
7

H.

McLeod:

H. McL.:
Present
and
Treatment

Present

Concepts

of

Concepts
of Pathof Bronchiectasis,

Pathogenesis,

Morbidity,

Mortality,
and Treatment
of Bronchiectasis,
Dls. of Chest,
9:5, 1943.
Roles,
F. C. and Todd,
G. S.: Bronchiectasis;
Diagnosis
and Prognosis in Relation
to Treatment,
Brit.
M. J., 2:639,
1933.
Clagett,
0. T. and Deterling,
R. A. Jr.: A Technique
for Segmental
Pulmonary
Resection
with
Particular
Reference
to Lingulectomy,
J. Thorac.
Surg.,
15:227,
1946.
Arey,
L. B.: Developmental
Anatomy,
W. B. Saunders
Co.,
Philadelphia
and London,
1924.
Cunninghams
Text
Book
of Anatomy,
Edited
by Arthur
Robinson;
William
Wood
and
Co., New York
City, 1931.
Mackiln,
C. C.; Quoted
by Best, C. H. and Taylor,
N. B.: The Physiological

Basis

of

Medical

Practice,

Baltimore,
Maryland,
1945.
8 Best,
C. H. and Taylor,
N. B.:
Practice,

The

Williams

and

The

Williams

and

Wilkins

Co.,

The

Physiological
Basis
of Medical
Baltimore,
Maryland,
1945.
of Histology,
Longmans,
Green
and

Wilkins

Co.,

9 Schafer,
E. A.: The
Essentials
Co., London,
1916.
10 Lambert,
A. E.: Histology
and Microscopic
Anatomy,
P. Blakinstons
Sons and Co., Inc., Philadelphia,
1930.
11 Marden,
T. B.: Manual
of Normal
Histology,
Hoen
and Co., Baltimore,
Maryland,
1924.
12 MIller,
W. S.: The
Lung,
C. C. Thomas
Co., Springfield.
13 Rilance,
A. B. and
Gerstle,
B.: Bronchiectasis
Secondary
to Pulmonary
Tuberculosis,
Am. Rev. Tuberc.,
48:8, 1943.
14 Perry,
Kenneth
M. A. and King,
D. S.: Bronchiectasis,
Am.
Rev.
Tuberc.,
41:531,
1940.
15 Farrell,
J. T.: The
Importance
of Early
Diagnosis
in Bronchlectasis:
Clinical
and Roentgenological
Study
of 100 Cases,
J.A.M.A.,
106:92,
1936.

16 Singer,
J. J. and
Graham,
E. A.: Roentgen-Ray
Studies
of Bronchiectasis,
Am. J. Roentgenol.,
15:54,
1926.
17
McNeil,
C., MacGregor,
A. R. and Alexander,
W. A.: Studies
of Pneumonia
in Childhood,
Bronchiectasis
and Fibrosis,
Arch.
Dis.
Child.,
4:170,
1929.
18 Richards,
G. E.: Interpretation
of Triangular
Shadows
in Roentgenograms
of the Chest,
Am. J. Roentgenol.,
30:289,
1933.
19 Anspach,
W. E.: Atelectasis
and Bronchiectasis
in Children,
Am. J.

Downloaded From: http://journal.publications.chestnet.org/ on 11/14/2014

216

BERNARD

is

now

now

thought
attributed

streptococcus.
to

to

be

by

many,

The

tenet

that
observers

the

bronchiectasis.

claim

if the

the

case
up

lymphatic

The
coughing

of
the

cyanosis;

with

acute

attacks,
from

especially
during
slight
streaking,
to

less
To

the

often.
diagnose

constant
what

early

seems

lobe

with

to

with
or
respiratory

be

may

bronchlectasis.
done.
growth,

If

there
is any
or pressure
be done.
treatment

of

affected

the

50 to
of

124

any

and

60 per

of

or

cent,

lobectomies,

in

the

the

low

of

frequent

act

may

hangs
vague

case,

bronchography

a 2.4

In
per

1940,
cent

done;

an

atelectatic
or

bronchiectasis;
and listlessness,

on after
hint
of

is

be

state,
necessary;
sinusitis,

an
acute
developing
should

atelectasis
from
the
bronchus,

still

like
varying
all give

are

be

that
first

bronchiectasis

general.

Downloaded From: http://journal.publications.chestnet.org/ on 11/14/2014

to

early
loss,

operations,
methods
ago,
carried

temperature

prebronchiectatic

by
weight

can

easy;
the
dyspnoea

at some
time,
a
muscles,
and
often
is also
seen,
but

be complicated
temperature,

this

supporters.

hemoptysis
hemorrhage,

subacute

cough,
be the

of

possible
route,

pneumonia

the

advanced

with

the

in

controlled;

most

grade

the

pneumonia

suspicion
of
from
outside

if

by

be improved
protagonists

is usually
sputum;
the

readiness

suspected

areas

caused

two
inhalation

developing;

other
segmental
are
the
surgical
twenty-five
years

former
present

frequently

be

The

months;
pulmonary

and

unresolved

In

should
The
lectomy
occasionally
lobectomy

the cold
massive

without
marked
Infection,
may

is

postulate
the

diagnosis.
There
is present
along
the paravertebral
frank
rheumatoid
arthritis

already
low grade

the

very

can

having

history

suspicion

many

some

cannot

bronchiectasis
of purulent
fingers;

bronchiectasis

bronchitis,
the persistent

sinusitis

bronchiectasis,

diagnostic

by

present

is

anerobic

from

is

odor

the

and

sinusitis

1949

and
that
very
little
permanent
medical
or surgical
treatment

the

to the
especially
neuralgia;

considered

sinusitis

former

clubbed

exacerbations;

leads

is

process.
swing
away

bronchiectasis
to the bronchi:
the

This

as

that

of advanced
large
amounts

and

group.

early
bronchiectasis
sinusitis
present.

route,

diagnosis
up of

definite
myofascitis,
segmental

the

found

accompanying

often
a
clearing

this

organisms,

bronchiectasis;

that

the
sinusitis
etiology
of
routes
of spread
of infection
and

of

with
bronchiectasis;
be secured
by either

and
very
by merely

February,

catarrhalls

in the
disease
is a marked

I have

bronchiectasis

by

other

is a cause

even

associated
result
can

caused
to

part
there

sinusitis

day

rarely

Neisserla

play
little
or no
In some
quarters,

McGOVERN

E.

be

a mucus
plug,
bronchoscopy

surgical

removal

lobectomy,

lingu-

or

even
pneumonectomy
in use.
The
operation
a mortality
rate
of
Churchill25
mortality.

reported
Others

of
about

a series
reported

Volume

XV

no

THE

mortality

PROBLEM

from

this

OF

operation

and
Belsey24
gave
impetus
mental
resection,
particularly
Graham6
the
right
one

reported
middle

the

to

during
the
tissue
as it applied

successful
and
the

lobe,

217

BRONCHIECTASIS

lingula

recent

years.

saving
to the

operation
lingular

removal
of

of

Churchill
of segsegment.

both
lower
lobes,
left
upper
lobe,
in

the

patient.
The

is

treatment

of bronchiectasis

palliative:

postural

sulpha

drugs,

tration;

or

and

vaccines

hygenic

as

of

dry

or

emphasized;

and

stricting
in drops
in

in

on

overuse
become

vasoconstrictlng
swollen

is

as

well

in the
in the
of vaccines

surprisingly

good

results

the

regenerative

In

children,

a child
growth.

will
In

stock
patients

necessary;

the

patients
There
are

that

may

first

place,

local
While

more

make

the

these

of
with

often

sputum
points

an

difference

but

least;
doses,
weeks

may
small

and

be taken.
enough

gives

children.

a defect

related
vaccine
vaccine

kept

however,
which
or even

often

In

has reached
adult
be found
that
the

or
up

to
may
made

in

success
be

for

or hyper-

and

part

mucus
vasocon-

drainage
bony

in

superior,

preferable.
use of vaccines

must

the

over
many

vasoconstrictors,
tipped
applicator,

especially

autogenous

between

treatments

months
doses

of

closely
enough
autogenous

an

of

drops
until
with
paralized

incision

is

treatbe

tendency

when
the
will
sometimes

becomes
in the

years
at
between
to two

is

ages,

power

antigens
that

but

a couple
started

all

contains
pathogens

of time,
several
year,
the
periods
may
be lengthened
of
be

at
smaller
it

own
several

prompt

body.
Also,
removal
of
nose
are
necessary.
in early
bronchiectasis

be relatively
using
vaccines,

vaccine
own

be

as

protein
residence
may
have

cannot

limited
use
with
a cotton

indicated

an abscess
elsewhere
plastic
obstructions
The
proper
use

The
tonsilitis

nasal
6oggy

acute
general

adequate

pernicious

and

the

complications;
Climate
itself

and

muscles,
the
judicious,
or by local
application

sinusitis

including

the

admInis-

during

bronchiectasis.

of

surgery

penicillin,

autogenous);

cardiac
useful.

sinusitis

for

aerosol

helpful

especially

the
all

spite

or

all

nutrition,
to
are

chronic

advanced
drainage;

parenteral
are

and

influence

acute

people
to
membranes

mouth

proper

attention
climate

ameliorating

ment

by

by
(stock

measures

and
vitamines;
in a warm,
an

drugs

is too

bronchoscopic

streptomycin

sulfa

episodes;

that

and

the
not
from

bronchiectasis
failure;

for

in

long

the

periods

after
a time,
such
as a
may
have
been
one week,
a month;
and
rest periods
to

The
administration
avoid
large

general

should
and

reactions.
allergy

pollens,
often
by preparing

to

such

precedes
the
tract

extrinsic
infection
in
for chronic

Downloaded From: http://journal.publications.chestnet.org/ on 11/14/2014

agents

as

foods,

epidermals,

the
respiratory
tract
sinusitis,
bronchitis,

or

and
acts
or bron-

218

BERNARD

chiectasis,

there

Intrinsic
patient
this

the

can

found,

be

Over
Springs,
thorax
these

years
the

and
phrenlc
methods
were

very
with
in

that
and

poor,
hard,
the

hand,

cases

of

is understandable
squeezes
out
respiratory

pull
the
which

space

secretions

it produces

and
it produces
local
fibrosing
mainly
anaerobic,
encourage
However,

phrenic

portant
hemorrhage

place

one
of
possible
basal

the

paralysis,

of

the

uncollapsible
by
3) pneumoperitoneum
of

using

advanced
dilated

cases
bronchi.

results

recently

enough;
stops

This

the
the

collapse
rythmical,

bronchial

as

time,
were

pneumothorax.

it

units,
and

aids

inhibits

and

walls;
and
thus

fibrotic
the

treatments
Probably

lung,

of aerobes;

Banyais

the

and
were
might

pneumoperihave

very

im-

for
massive
pulmonary
the most
universally
useful

1)
which

because
lung

frequent

pneumothorax
is usually

these

as

it

smaller
reduces

obliteration;

growth

pneumothorax

these
is pneumoperitoneum:
to determine
immediately

reversible

old,
the

early

organisms.
procedures

as emergency
in bronchiectasis.

portion

at the same
Our
results

excellent

well

in
out

acute
cause

a slowed
circulation
with
its bacteriostatic
effect.
Of course,
if the
bronchial
infection
the
collapse
therapy
in bronchiectasis

the
growth
of
minor
collapse

toneum,

practicing
there,
tried

Infection-weakened

as

is

Colorado
pneumo-

by

which

extrinsic
antigen

was

disease
is
secretions;

collect

the
when

an

reported

anoxia

the

middle
age
after
no extrinsic
allergenic

of the
infected
lung
little
or no cartilage,

to

a relative

with

bacteral

because
we chose
scar
tissue
around

the

walls
contain

whom
and

years

for bronchiectasis;
extensively
elsewhere.

bronchiectasis

on

approximates
bronchi,
for

explanation.
while
I
specialists

if the
infective

the

In

this

Hennell27

early

for

intrinsic

1949

making

allergens;

treated

the

ago,
chest

probably
mainly
thick,
unyielding
other

four

be

in

sensitizer,

extrinsic

develops
for which

paralysis
tested

patients

a basic

the

until

February,

of

as

may

supports

twenty
Colorado,

act
to

results

asthma
Infection

number

to

patient

without
The

lesser

susceptible

happens,

added.
respiratory

seems

more

allergens

On

are

Infection

E. McGOVERN

It is not
is bleeding;

bleeding

site,

because
of
pleural
the
least
dangerous

always
2) the
is

often

adhesions;
and
most

procedures.
SUMMARY

The

incidence

Bronchiectasis
inception,

of bronchiectasis
runs

and

usually

serious
complications
the
brain
and
other
pleural

empyema

claims
are:
parts

and

Downloaded From: http://journal.publications.chestnet.org/ on 11/14/2014

is greater

progressively

attacks

its

victims

heart
of the

failure,
body,

of

than

generally

downward

pneumonitis

in

realized.

course
the

third

metastatic
anyloidosis,
or

from
decade.

its
Its

abscesses
to
lung
abscess,
pneumonia.

Volume

XV

THE

Leaving

aside

mental
Infection;
the

PROBLEM

congenital

malformations,
stenosis

bronchial

ened

of

elements;

walls,

cause
bronchi;

the

with

be

which

and

other

respiratory
infection

of

inspiratory

pull

by

develop-

is

destruction

augmented

increase
the
bronchiectasis

for

and

bronchlectasis
lack
of drainage;

rythmlcal

may

valve
mechanism,
The
best treatment

cysts
of

weakening

the

which

219

BRONCHIECTASIS

bronchal
the

walls

supporting

OF

the

on

atelectasis

or

stretching
effect
is prevention

of

elastic

the

weak-

check-

on the walls.
or treatment

of the early
phase:
removal
of a plug
of mucus
causing
atelectasis
following
bronchial
or virus
pneumonia
or other
respiratory
Infections;
prompt
treatment
of a subacute
or chronic
bronchitis;
prompt

treatment

piratory

allergies;

for

sinusitis

and

removal

of

of

extrinsic

endobronchial

tumors,

tracheobronchial

and

antibiotics;

general

genous
The
if the

patient

has

of lobectomy,
tomy.
The
and

glands;

hygiene

and

his

ferred

stock)
advanced

not

advanced

segmental
younger
patient

greater

risk

to

stage.

or

(auto-

a warm,
dry
Is mainly

climate.
surgical,

This

consists

and
occasionally
pneumonecsuperior
regenerative
power

physiological

operations

drugs

vaccines

a terminal
his

and

in

enlarged

sulpha

nutrition;

res-

treatment
and

as

sometimes
bronchiectasis

resection,
with

anatomical

surgical

such

good

to

bodies;
tumors

drugs

and

attention

foreign

extrabronchial

hilar

or occasionally
treatment
for

tonsilitls;

for

reserves

is the

pre-

bronchiectasis.

RESUMEN
La

frecuencia

mente
Desde

se

de

gresivamente
en

la

tercera

ciOn

Ia

la infecciOn

y destrucciOn
respiratoria

de
ritmica

aumentado
El

sea,
tapOn

alto

el

coneumonla

un

reclama
graves

al

cerebro

generalcurso

sus

son:
a

pro-

victimas

insuficiencla

otras

empiema

los

aumenta
tratamiento

tratamiento
de moco

quistes

bronquiales

la

de

causa

estenosis

de

de las

por
que

mejor

10 que

prosigue

10 general,

pulmonar,

los

desarrollo,

respiratoria;

retenciOn

de

partes

pleural

del

y ataques

o neumonla.
del

lizaciOn;

mayor

complicaciones

absceso

por

anomallas

y, por

metast#{225}stlcos

amiloidosis,

neumonitis

es

bronquiectasia

d#{233}cada. Sus

Pasando

ser

la

abscesos

cuerpo,

bronquiectasia

descendiente

cardlaca,
de

la

supone.
sus
principios

que

el

efecto

de la
cause

Downloaded From: http://journal.publications.chestnet.org/ on 11/14/2014

bronquios;

la

un
de

la

falta

con

la

tensiOn

sobre
es

virus

o a

otras

de

cana-

la tensiOn
que
puede

10
de

bronqulectasla

otras

debilitamlento

mecanismo

fase
temprana:
la
atelectasia
subsigulente
de

es la infec-

el#{225}sticos de soporte;
paredes
debllitadas,
o

de

congenltos

bronquiectasla

bronquiales

atelectasia

o neumonla

los

paredes

elementos
sobre
las

la

la

v#{225}lvula de
las

extracclOn
a una

infecciones

paredes.

profllaxia,

o
de un
bron-

respira-

220

BERNARD

torlas;

el

crOnica;

tratamiento
el

de

las

extraflos
extrinsecos;
o extrabronquiales
hlpertroflados;
el
o

los

las

higiene

ocasionalmente
superior
poder

no
de

es el riesgo

y la

extracciOn

tonsilitis;
de

buena
no

avanzada

ha avanzado
lobectomia,
El
y

subaguda
y

ocasionalmente,

neumonectomla.
regenerativo

y fisiologicas

la

1949

el
cuerpos

de tumores
endobronqulales
tr#{225}queobronquiales
e hiliares
tales
como
las sulfonamidas

general

u,

paciente
consiste

bronquitis
senositls

respiratorias;

c#{225}lldoy seco.
de la bronquiectasla
el

February,

la
de

el tratamiento
y de
ganglios
empleo
de drogas,
la

qulr#{252}rgico,
si
Este
tratamiento

la

alergias

(autOgenas

un clima
tratamiento

de

oportuno

antibiOticos;
vacunas

veces,
El

oportuno

tratamiento

tratamiento

E. McGOVERN

sus

quirUrgico

alimentaciOn;
autOgenas)

y,

es principalmente

a un
resecciOn

estado
terminal.
segmentaria

paciente
mayores

m#{225}sjoven,
con
reservas
anatOmicas

preferido

en

operaciones

y,
su

para

bronqulectasia.
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