病理学——呼吸系统.pptVIP

High-Resolution Computed Tomography The clinical manifestations consist of severe, persistent cough with expectoration of mucopurulent, sometimes fetid, sputum. The sputum may contain flecks of blood; frank hemoptysis can occur. Symptoms are often episodic and are precipitated by upper respiratory tract infections or the introduction of new pathogenic agents. Clubbing of the fingers may develop. In cases of severe, widespread bronchiectasis, significant obstructive ventilatory defects develop, with hypoxemia, hypercapnia, pulmonary hypertension, and (rarely) cor pulmonale. Metastatic brain abscesses and reactive amyloidosis (Chapter 5) are other, less frequent complications of bronchiectasis. Most individuals have never smoked (55%) or have smoked too little to account for their degree of cough, findings of obstruction on spirometry testing, and daily sputum production. Sputum is typically mucoid and without a rancid odor; however, during infectious exacerbations, sputum becomes purulent and may develop an offensive odor. In the past, total daily sputum amount has been used to characterize the severity of bronchiectasis, with less than 10 mL defined as mild bronchiectasis, 10-150 mL defined as moderate bronchiectasis, and greater than 150 mL defined as severe bronchiectasis. Today, bronchiectasis is most often classified by radiographic findings. Hemoptysis is generally mild and manifested by blood flecks in the patients usual purulent sputum. This is often the factor that leads patients to consult a physician. Bleeding usually originates from dilated bronchial arteries, which contain blood at systemic (rather than pulmonary) pressures. Therefore, massive hemoptysis may occur but is rarely a cause of death. Restrictive disease is so named because it restricts the ability to take a deep breath, i.e., the lung is small, contracted and cannot expand properly. Therefore, air cannot get in. Causes include: Chest wall stiffness or immobility (e.g., muscle paraly