Cough with clubbing
Introduction
Introduction The so-called clubbing refers to the obvious widening and thickening of the end knuckles, and the nails are curved from the root to the end. Cough with clubbing can be seen in bronchiectasis (bronchodilation can be divided into congenital and secondary. Congenital less common, due to congenital bronchial dysplasia, congenital defects or hereditary diseases, secondary The main pathogenesis of bronchiectasis is repeated infection of the bronchi and lung, bronchial obstruction and bronchial involvement, three factors affect each other.), chronic abscess.
Cause
Cause
(1) Causes of the disease
Bronchiectasis can be divided into congenital and secondary. Congenital less common, due to congenital bronchial dysplasia, congenital defects or hereditary diseases, so that the lungs can not further develop the periphery, resulting in developed bronchiectasis, such as bronchial cartilage hypoplasia (Williams-Camplen syndrome). Some patients have bronchiectasis after birth, but there are also congenital anomalies. For example, Kartagener syndrome, patients with bronchodilation may be associated with visceral ectopic and pancreatic cystic fibrosis, which is actually a cilia-free exercise synthesis. A subtype of immotile cilia syndrome. Bronchiectasis can also be seen in Young syndrome, which is characterized by obstructive sperm deficiency, chronic sinusitis, repeated lung infections, and bronchiectasis. Some patients with bronchiectasis show immunoglobulin defects. IgG deficiency is prone to repeated bacterial infections, with IgG2 and IgG4 deficiency being more important.
(two) pathogenesis
Bronchiectasis can be divided into columnar, saclike and mixed forms according to its morphology. Congenital is mostly cystic, and secondary is mostly columnar. The columnar wall of the columnar expansion is lightly damaged, the appearance of the bronchus is regular, the diameter of the tube is not significantly increased, and the square is expanded only at the end. As the disease progresses, the bronchial inflammation spreads to the peripheral lung tissue, causing its destruction and fibrosis at the distal end. It forms a cystic dilatation, which is honeycomb-shaped, often with sputum retention and secondary infection, which further enlarges the cyst. Inflammation spreads to the adjacent lung parenchyma, causing varying degrees of pneumonia, small abscesses, and lobular atelectasis.
Examine
an examination
Related inspection
Lung biopsy bronchoscopy hand deformity examination
I. Symptoms
The course of bronchiectasis is mostly chronic and can occur at any age. The onset can often be traced back to a history of pneumonia after childhood measles, whooping cough or influenza, or a history of tuberculosis, endobronchial tuberculosis, and pulmonary fibrosis. Symptoms may appear several years later. Typical symptoms are chronic cough, massive cyanosis, and repeated hemoptysis. Cough is the most in the morning, evening, and bedtime, up to 100-400 ml per day, and many patients have almost no cough at other times. When the cough is smooth, the patient feels relaxed; if the drainage of the sputum is not smooth, the chest is stuffy and the systemic symptoms are obviously aggravated.
Second, diagnosis
The diagnosis is based on:
1. History of respiratory infections that induce bronchiectasis in childhood, such as history of measles, whooping cough or post-flu pneumonia, or history of tuberculosis.
2. Long-term chronic cough, cough and sputum or repeated hemoptysis.
3. Physical examination Auscultation of the lungs has a fixed, persistent wet sound, clubbing (toe).
4. X-ray examination showed that the lungs were increased in texture, thickened, and arranged disorderly. Curly-like shadows were observed, and small fluid level appeared in the infection. CT typical performance was orbital sign or ring sign or grape sign. Diagnosis depends on bronchial lipiodol or HRCT. Suspected congenital factors should be examined, such as serum Ig concentration determination, serum -globulin determination, pancreatic function test, nasal or bronchial mucosal biopsy.
Diagnosis
Differential diagnosis
1. Chronic bronchitis is more common in middle-aged patients, coughing, coughing or wheezing in winter and spring, mostly white mucus sputum, and may have purulent sputum when infected. In the acute attack, there are scattered dry and wet sounds at the bottom of both lungs. Unlike the fixed wet sound of bronchiectasis, the wet sound of the disease is variability, and the wet sound can disappear after coughing.
2. Lung abscess has an acute onset process, chills, high fever, when coughing a large amount of purulent sputum, body temperature drops, systemic toxic symptoms are alleviated. X-ray shows a large piece of dense inflammation shadow, with a cavity and liquid level in between, and can be completely resolved after treatment with effective antibiotics in the acute phase. Chronic lung abscess has a history of acute lung abscess, often with bronchiectasis, bronchiectasis can also be complicated by lung abscess, the diagnosis depends on bronchial lipiodol or HRCT.
3. Tuberculosis often has symptoms of tuberculosis such as hypothermia, night sweats, general malaise, weight loss, etc., with cough, cough, hemoptysis, and generally less sputum. The sound is generally located at the tip of the lung. The chest radiograph is mostly patchy infiltrating shadow on the upper part of the lung. The tubercle bacillus or PCK tuberculosis DNA can be found in the sputum.
4. Congenital pulmonary cysts have cough, cough, and hemoptysis after secondary infection. After the disease is controlled, the chest radiograph shows multiple round shadows with clear boundaries, thin walls and no infiltration of surrounding lung tissue.
5. Identification with lung cancer.
