Improved plain film criteria for the diagnosis of bronchiectasis

This manuscript establishes criteria that allow more accurate detection of bronchiectasis from plain films. Chest radiographs of 38 patients with proven bronchiectasis were evaluated for seven radiologic signs: bronchial dilatation, identified by visually comparing bronchial diameters in affected areas to bronchial diameters in normal areas an equal distance from the hilum; signet ring sign, with dilated, thick-walled bronchus adjacent to a smaller companion artery; bronchial wall thickening; volume loss; compensatory hyperinflation of surrounding segments or lobes; mucoid impaction of bronchi; and obvious cyst formation. The chest radiograph was abnormal in all 38 cases. Bronchial dilatation was present in 100%, signet ring sign in 79%, bronchial wall thickening in 92%, volume loss in 97%, compensatory hyperinflation in 58%, mucoid impaction in 45%, and cyst formation in 42%. By combining these signs, a very certain diagnosis of bronchiectasis was possible. Measurements of the pulmonary artery-bronchus ratio (ABR) in cases demonstrating the signet ring sign were useful in validating the signet ring sign as a good sign of bronchiectasis on plain films. Overall, the chest radiograph showed 235 (92%) of the 255 bronchiectatic lung segments identified by bronchography or high-resolution computed tomography.