examination and diagnosis of bronchiectasis in the elderly
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Common examination of bronchiectasis in the elderly
- Check nameInspection siteInspection departmentCheck function
- BronchoscopeTracheopulmonaryDepartment of Respiratory Health CareBronchoscopy...
- Occult blood test and hemosiderin testPulmonary tracheaRespiratory special needs wardOccult blood test and containing...
- Chest CTChest--Chest CT examination can...
- Chest plain filmChest--Chest X-ray adaptation...
- BronchographyLung-- 【小于】i> Bronchography is...
- Sputum bacterial smearLung--Sputum smear bacterial stain...
- Sputum bacterial cultureLung--Bacterial culture of sputum...
A large number of neutrophils can be seen in sputum If the smear is examined by Gram staining, related bacteria can be seen. The main pathogenic bacteria in sputum culture are pneumococcus, Haemophilus influenzae, etc. Pseudomonas aeruginosa is also a common bacterium. Staphylococcus aureus, anaerobes and non-tuberculous mycobacteria can be seen in others.
1. X-ray chest plain film
It is not a specific examination method for bronchiectasis. Bronchiectasis is caused by wall thickening and peripheral connective tissue hyperplasia caused by chronic inflammation of bronchial wall, which is characterized by increased, thickened and disordered texture in lesion area. If there is secretion retention in the dilated bronchus, it is columnar thickening. On plain film, curly hair shadow distributed along bronchus can be seen in severe cystic bronchiectasis, and short liquid flat can be seen in curly hair shadow when secondary infection occurs. Because bronchiectasis is often accompanied by interstitial inflammation, the lung texture is increased with reticular changes. Generally, patients with bronchiectasis have no obvious abnormal changes and no specificity on chest plain film. Even if the above-mentioned characteristic changes of bronchiectasis are seen, the severity, nature and lesion range of bronchiectasis cannot be determined according to this.
2. Bronchial lipiodol angiography
It can diagnose the severity, location and scope of bronchiectasis, and the type of lesion, which is the most important basis for diagnosing bronchiectasis, and has certain significance for whether it can be operated and the scope of resection. In order to make the angiography satisfactory and prevent the occurrence of complications, it is required to have a good anesthetic effect when angiography, so that patients can cooperate well. Children under 10 years old are not easy to cooperate, so it is not suitable to do this examination. The viscosity of lipiodol contrast agent should be just right, which can infuse grade 7 ~ 8 bronchi. When it is too thin, lipiodol is easy to enter alveoli, while when it is too thick, bronchioles are poorly filled, which will affect the correctness of film reading. Blending sulfanilamide powder should be appropriate, so as to make the viscosity appropriate. Although bronchial lipiodol angiography can make a definite diagnosis, it is not suitable to do bronchial lipiodol angiography for patients with mild symptoms who do not plan to undergo surgical resection, or for patients with severe lesions, especially bilateral cases, heart and cardiopulmonary insufficiency, so as to avoid unnecessary pain and accidents.
3. CT scanning
High-resolution CT used in clinic in recent years can accurately diagnose bronchiectasis, There is a tendency to gradually replace bronchography, Lung CT is typical for patients who are not suitable for bronchography and clinical symptoms, Patients with suspected bilateral bronchiectasis, CT examination can provide the presence or absence of lesions and the scope of lesions, According to the reports of some scholars, The sensitivity and specificity of CT in diagnosing bronchiectasis were 63.9% ~ 97.0% and 93% ~ 100%, respectively. Thin-slice scanning with slice thickness of 0.5 mm or 1.0 was easier to find bronchiectasis than conventional scanning. Thin-slice scanning could reduce volume effect, and high-resolution scanning made the image clearer. Lung CT could diagnose segmental and subsegmental bronchiectasis, but smaller bronchiectasis was difficult to diagnose. High resolution CT scan can show 2mm diameter bronchus, but【小于】1mm bronchus cannot be displayed. It is easier to distinguish cystic bronchiectasis from columnar bronchiectasis. The types of bronchiectasis, whether there is infection or not, and whether there is secretion in bronchus can be different on CT, When there is mucus column or infection in columnar bronchiectasis, it shows columnar or nodular high-density image, and when there is no secretion in the lumen, it shows annular, elliptical annular or tubular image. The diameter of bronchus is often significantly larger than the accompanying pulmonary artery diameter, and the wall is thickened; Cystic bronchiectasis is characterized by concentrated distribution, smooth cavity changes inside and outside the wall, and liquid level can be seen inside it, which is generally located in the middle and inside of the lung field. Bronchiectasis is caused by the traction of lung lesions. It often leads to bronchial distortion, often accompanied by consolidation of lung lobes or segments.
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