The value of computed tomography in the diagnosis and management of bronchiectasis.

In order to evaluate the usefulness of computed tomography (CT) in the diagnosis and management, as distinct from only the diagnosis, of bronchiectasis, we retrospectively reviewed the clinical, lung function, and radiological data of 38 patients suspected of having the disease. All had chest radiographs, CT scans, and bronchograms. The approach was to examine the radiological investigations with the clinical data in three stages: I, chest radiograph; II, CT; III, bronchography (BG), as if they were newly presenting cases. At the end of each stage, a decision was made either to proceed to the next stage or to stop because further investigation was considered unlikely to alter management. Apparent normality, equivocal abnormality, or unilateral abnormality were criteria for proceeding. Unfitness for surgery, unequivocal bilateral disease, or mild disease were criteria for stopping after a firm diagnosis had been made. We stopped at stage I in four patients (11%) because the chest radiograph showed bilateral bronchiectasis and two had poor lung function. We stopped at stage II in 15 patients (39%): 12 had bilateral disease on CT; three had unilateral disease on CT but their clinical features were so mild that BG was considered unjustified. Scrutiny of the CT and BG films of those patients who were judged not to require CT or BG in the retrospective review confirmed that these would not have altered their management. Of the remaining 19 patients who proceeded to stage III, BG was useful in 15 (39%) by confirming or refuting CT findings, but was not useful in four (11%) because of underfilling. We conclude that optimal use of chest radiographs and CT in patients suspected of having bronchiectasis can significantly reduce the necessity of performing BG.