Bronchiectasis

Abstract

The history of bronchiectasis is a good example of the influence of radiology on clinical and pathological ideas. Bronchiectasis or dilatation of the bronchi was first described in the early part of the nineteenth century by Cayol and Laennec, and the description of these early workers remained practically unaltered for the better part of a century. A group of signs and symptoms, notably cough, abundant foul sputum, pyrexia, and clubbing of the fingers, were held to be characteristic, and the autopsy findings of a suppurative pneumonia, with bronchiectatic cavities, inevitably confirmed the clinical diagnosis. Before the radiological era, however, suspicion was arising that these characteristic signs and symptoms were late developments, and that any or all of them might be absent in the earlier stages of the disease. At the same time an enormous amount of work was being done on the etiology and classification of the disease, and it is interesting to note in this connection that the pre-war classification of Barty King differs little from the most exhaustive recent work of Ballon, Singer, and Graham. As soon as radiology was applied to the study of diseases of the chest, the diagnosis, pathology, and prognosis of bronchiectasis underwent a remarkable change. The early chest radiologists, unsupported by either clinical or autopsy evidence, succeeded in describing the appearances of the dry form and separated it from tuberculosis, and they also suggested the existence of many intermediate forms, both dry and infected. The introduction of lipiodol in 1925 fully sub-stantiated their conclusions.