Causes of bronchiectasis in children, based on distribution

Localized

Foreign body aspiration

Intraluminal obstruction (eg, foreign body, mucus plug, tumor)

Congenital abnormality (intralobar bronchopulmonary sequestration, bronchial stenosis, bronchomalacia, tracheal bronchus)

Extraluminal compression (lymphadenopathy [eg, tuberculosis], vascular compression, or cardiomegaly)

Past severe local pneumonia

Chronic localized atelectasis or infection (eg, chronic right middle lobe syndrome, mucus plugging)

Generalized

Upper lobe predominance

Cystic fibrosis*

Aspiration syndrome in nonambulating children

Sarcoidosis

Central airways

Allergic bronchopulmonary aspergillosis

Mounier-Kuhn syndrome (may also affect lower lobes if repeated infections)

Lower lobes predominance

Immunodeficiency (specifically, hypogammaglobulinemia)

Chronic aspiration in ambulating children

Interstitial pneumonia

Idiopathic

Middle lobe and lingual predominance

Primary ciliary dyskinesia

Atypical mycobacterial infection

The distributions described in this table are general observations and are not sufficient to diagnose a specific cause of bronchiectasis. In addition, advanced imaging methods such as HRCT with or without MDCT typically detect more diffuse disease compared with conventional radiography. Also, some studies including relatively large cohorts (n = 105) report that the distribution of bronchiectasis did not differ between children with and without underlying conditions^[1].

HRCT: high-resolution computed tomography; MDCT: multidetector computed tomography.
* In chest radiograph-based studies, cystic fibrosis has an upper lobe predominance, but this is not a consistent finding in CT-based studies^[2,3].

References:

Santamaria F, Montella S, Pifferi M, et al. A descriptive study of non-cystic fibrosis bronchiectasis in a pediatric population from central and southern Italy. Respiration 2009; 77:160.
Marchant JM, Masel JP, Dickinson FL, et al. Application of chest high-resolution computer tomography in young children with cystic fibrosis. Pediatr Pulmonol 2001; 31:24.
Kim HY, Kwon JW, Seo J, et al. Bronchiectasis in children: 10-year experience at a single institution. Allergy Asthma Immunol Res 2011; 3:39.

Adapted from: Javidan-Nejad C, Bhalla S. Bronchiectasis. Radiol Clin North Am 2009; 47:289.

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Causes of bronchiectasis in children, based on distribution