Traction bronchiectasis in end-stage pulmonary fibrosis

Postmortem examination of the lungs of 12 patients with end-stage pulmonary fibrosis revealed the frequent (nine of 12) presence of bronchiectasis. The segmental and subsegmental bronchi were dilated, tortuous, and had a convoluted appearance that resembled a string of pearls. Bronchiectasis was confined to areas of advanced fibrosis. When fibrosis was mild or when it was combined with emphysema, bronchiectasis was absent or mild. Specimen radiographs revealed that bronchiectasis frequently contributed to the radiographic appearance of honeycombing. Retrospective analysis of the plain chest radiographs obtained from five of the patients revealed evidence suggestive of bronchiectasis, but bronchiectasis was difficult to detect unless the surrounding lung was radiopaque. In two living patients with end-stage pulmonary fibrosis, bronchiectasis was much better depicted on computed tomography scans than on plain chest radiographs. In patients with pulmonary fibrosis, the presence of bronchiectasis does not necessarily imply the presence of primary bronchial disease. Rather, bronchiectasis can be a direct result of the fibrotic process.