Upper Lobe Bronchiectasis as a Chest Clinic Problem

BRONCHIECTASIS is one of the commiionest conditions encountered at a chest clinic. Five years ago Whitewell (1952) believed that bronchiectasis was almost as common as tuberculosis. Heller (1946), in Hounslow Chest Clinic, found it ranking onlv after pulmonary tuberculosis and chronic bronchitis as a cause of haemoptysis. Alinarik (1956) discovered 51 cases of bronchiectasis adnmitted as tuberculosis to his sanatorium between 1952 and 19,55. \Vhen bronchiectasis inivolves the upper lobe bronchus, differential (liagnosis from active pulmonary tuberculosis mlav at first sight be difficult and require observation in hospital. T'he purpose of this communication is to give some indication of the freqluency withl which upper lobe bronchiectasis may occur, and lhow it may, be differentiated from active pulmonary tuberculosis. Although bronchiectasis, except for rare congenital types, is recognised as being a secondary condition, it has been arbitrarily named primary bronchiectasis to distinguish it from types secondary to such disease as bronclhial carcinoma, inhaled foreign body and post-primary pulmonary tuberculosis (XVynne-Williams, 1957). Since tuberculous bronchiectasis is usually apical, so upper lobe bronchiectasis is most often tuberculous. Tuberculous bronchiectasis is very common, being found in 27.6 per cent. of 134 thoracoplasty cases of pulmonary tuberculosis coming to WVasserburger (1956) reported the results of both tomography and bronchography in 100 randomly selected tuberculous patients with apical disease. Bronchiectasis was found in no less than 74 per cent. of the total, being present in all 5 thoracoplasty cases, in 22 of 24 far advanced and 43 of 53 moderately advanced cases, but in not more than 1 of 18 nminimal cases. X-rays reproduced show that minor (legrees of ectasis were included in tlhese results. The post-mortem andi laboratory figures quoted probably reflect better the proportion of significant bronchiectasis to be expected in tuberculosis. Tuberculous bronchiectasis is not a major clinical problem. It is almost always of the upper lobe or apex of the lowrer lobe bronchus, and retention ol sputuLm1c does not often occur. On the other hand, non-tuberculous bronchiectasis of the upper lobe bronchus is less frequent and is stated by many authors to bc rare, e.g., Ritvo (1956) and toope (1948). The rarity of non-tuberculous bronchiectasis involving the upper lobe bronchus may be over estimated. In \Whitwell's report (WVhitwell, 1952) 200 specimens, resected because of bronchiectasis, includled 6 of the right and 5 of the left upper 19