Bronchiectasis, as the derivation of the word implies, is the name given to any condition in which there is dilatation of one or more bronchi. Since it is clear that increase in the diameter of a bronchus may result from a variety of conditions, among them infections and massive collapse, the term describes an anatomical abnormality rather than a single disease. A wide range exists both in the form and degree of the dilatation and in its distribution among the bronchi. As the reason for the diversity is not clearly understood, it is not possible at present to make a satisfactory classification of the miscellaneous conditions which are all grouped together as bronchiectasis. In this, as in any other disease, accurate study of the pathological anatomy is an essential step in its elucidation. But, although the abnormal morphology of the dilated bronchi is the outstanding feature, it has been imperfectly described. During the examination of the large number of bronchograms and specimens seen in the routine work of a chest unit, it was noticed that the number of subdivisions of the bronchi between the hilum and the periphery of the lung differed from case to case, and was frequently much smaller than in the normal lung. It was decided to investigate this apparent reduction, and, in the event of its being demonstrated, to determine the fate of the missing subdivisions. This paper is a report on the findings.

https://thorax.bmj.com/content/thoraxjnl/5/3/233.full.pdf

Reduction in Bronchial Subdivision in Bronchiectasis

Since the first description of bronchiectasis by Laennec in 1819 its pathogenesis has been a controversial topic, and although the many theories have their recurring moments of popularity, none has as yet found general acceptance. One reason for this lies in the widely varying views of different workers as to the essential nature of the disease. Nowadays the divergence of opinion seems to be occupational, for, while many physicians and radiologists think of the bronchial inflammatory changes as mild and the dilatations of a mechanical nature, most surgeons and pathologists regard bronchiectasis as a destructive inflammatory process. The pathology of bronchiectasis has been investigated for over a century and the various accounts are conflicting. It has been stated that many tissue changes described in the earlier literature could be attributed to terminal infections and post-mortem autolysis, and that operation specimens show less severe lesions which are more consistent with clinical findings. However, in several recent accounts the pathological changes described have been quite as advanced as those found in postmortem material, 'but such descriptions have been found unacceptable to many clinicians, who regard radiological findings as truer reflections of the underlying pathology. The popular acceptance of this view, with its effect on theories of pathogenesis, has stimulated the present investigation. It was thought that diversity in the described lesions of bronchiectasis might be explained by one or more of the following suppositions. (1) Histological sections may not have been selected (by different investigators) from comparable areas of lung tissue. (2) Variation of histology is due to the severity, extent, and duration of the illness. (3) Bronchiectasis is not a single pathological entity, but a group of differing conditions having bronchial dilatation as a common factor.-

https://thorax.bmj.com/content/thoraxjnl/7/3/213.full.pdf

A Study of the Pathology and Pathogenesis of Bronchiectasis

Correlated Applied Anatomy of the Bronchial Tree and Lungs With a System of Nomenclature

This brief history of topographical anatomy begins with Egyptian medical papyri and the works known collectively as the Greco-Arabian canon, the time line then moves on to the excitement of discovery that characterised the Renaissance, the increasing regulatory and legislative frameworks introduced in the 18th and 19th centuries, and ends with a consideration of the impact of technology that epitomises the period from the late 19th century to the present day. This paper is based on a lecture I gave at the Winter Meeting of the Anatomical Society in Cambridge in December 2015, when I was awarded the Anatomical Society Medal.

A brief history of topographical anatomy.

Boyden's nomenclature, which was based on postmortem specimens and published in 1955 prior to the advent of computed tomography (CT), is commonly used to describe the normal segmental bronchial anatomy and various abnormalities. However, several additional anomalies have been recognized since that time, and there is some confusion over the names used to describe these anomalies. Several congenital branching anomalies affecting the trachea, main bronchi, and intermediate bronchus have been reported, all of which can be recognized at chest CT but are often overlooked. These anomalies, which probably occur early in fetal life, can be either supernumerary, with defects occurring at 29-30 days gestation, or displaced, with defects occurring later. Tracheobronchial positional anomalies are often associated with other congenital abnormalities but may be isolated. They often are asymptomatic but can be responsible for pulmonary symptoms such as dyspnea, recurrent pneumonia, and hemoptysis. It is essential that these anomalies are recognized prior to lung resection to avoid complications, especially when video-assisted thoracoscopic surgery is performed. In addition, bronchoscopists should be aware of these anomalies before performing diagnostic or therapeutic bronchoscopic procedures. Awareness of a few key bronchial anatomic principles and use of a lobe-based classification scheme will facilitate recognition of tracheobronchial positional anomalies.

/pdf/tracheobronchial-branching-abnormalities-lobe-based-1rw0h4ewxs.pdf

Tracheobronchial Branching Abnormalities: Lobe-based Classification Scheme—Erratum

foreign white cells; and the red cells of the transfused blood were rapidly phagocytosed. There was no other evidence of incompatibility between the patient's blood,' which was Group A, and the donor's, which was Group 0. There was no reaction following the transfusion and no haemoglobinuria. The death of the patient seven days later was easily accountable by his general condition. The phenomenon of auto-erythrophagocytosis-ingestion by macrophages of the patient's own red cellshas been observed in vitro and has been described as occurring in the circulation in malaria and in trypanosomiasis by Connal (1912) and Macfie and Johnston (1913). In the literature consulted no reference was found to erythrophagocytosis either in agranulocytosis or as a result of blood transfusion. In this case the condition probably indicates either a degree of incompatibility between patient's and donor's blood insufficient to produce other reaction or, more likely, increased sensitivity of the patient to foreign red blood cells.

Anatomy of the bronchial tree.

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Anatomy of the bronchial tree.