Intentional Engagement
1. Findings
Axial CT – Lady Windermere Syndrome
61-year-old male with a history of treated mycobacterial infections including MAC and chronic cough.
Axial CT at the level of the mid to lower chest shows mildly ectatic segmental airways to the lower, and middle lobe bronchi but significant bronchiectasis to the middle lobe and lingula involving the subsegmental airways. There is a relative paucity of mucus in the ectatic airways. The history of MAC and the distribution of the bronchiectasis in the middle lobe and lingula are reminiscent of the diagnosis of Lady Windermere syndrome
Ashley Davidoff MD TheCommonVein.net 250Lu 135876
61-year-old male with a history of treated mycobacterial infections including MAC and chronic cough.
Axial CT at the level of the mid to lower chest shows mildly ectatic segmental airways to the lower, and middle lobe bronchi but significant bronchiectasis to the middle lobe and lingula involving the subsegmental airways. There is a relative paucity of mucus in the ectatic airways. The history of MAC and the distribution of the bronchiectasis in the middle lobe and lingula are reminiscent of the diagnosis of Lady Windermere syndrome
Ashley Davidoff MD TheCommonVein.net 250Lu 135876
Bronchiectasis – Classification by Cause
| TCV Category | Cause of Bronchiectasis | Notes / Imaging Patterns |
|---|---|---|
| Infectious | – Post-tuberculosis – Post-bacterial pneumonia – Viral (e.g., adenovirus, measles) – Fungal (aspergillosis/ABPA) |
Segmental or lobar; may be focal or multifocal; upper lobe in TB |
| Inflammatory / Immune | – Allergic bronchopulmonary aspergillosis (ABPA) – Autoimmune diseases (e.g., rheumatoid arthritis, Sjögren’s) |
Varicose or cylindrical; often central (ABPA), lower lobes in autoimmune |
| Inherited | – Cystic fibrosis (CF) – Primary ciliary dyskinesia (e.g., Kartagener syndrome) – Alpha-1 antitrypsin deficiency |
Cystic (CF), bilateral and diffuse Lower lobe (PCD), panacinar (A1AT) |
| Mechanical | – Bronchial obstruction (tumor, foreign body) – External compression (lymphadenopathy) |
Focal bronchiectasis; post-obstructive; may involve mucus plugging |
| Metabolic | – Hypogammaglobulinemia – Mounier-Kuhn syndrome (tracheobronchomegaly) |
Diffuse cylindrical or cystic; recurrent infections due to impaired defense |
| Iatrogenic | – Post-lung surgery (e.g., lobectomy) – Radiation-induced |
Focal; usually near surgical margins or irradiated zones |
| Traumatic | – Severe chest trauma (rare) | Localized scarring and traction bronchiectasis |
| Circulatory | – Pulmonary infarct with scarring | Uncommon; results in traction bronchiectasis |
| Infiltrative | – Sarcoidosis | Traction bronchiectasis due to fibrosis in upper/mid lung zones |
| Idiopathic | – No identifiable cause (~30–50% of cases) | Often cylindrical, multifocal; lower lobe or diffuse |
| Functional | – Chronic aspiration (due to GERD or swallowing dysfunction) | Lower lobe predominant; recurrent pneumonia history |
| Psychiatric / Psychogenic | (None applicable) | — |
✅ Summary:
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Most common overall causes: Post-infectious, Cystic fibrosis, Idiopathic, and ABPA
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Upper lobe: CF, TB, sarcoidosis
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Lower lobe: Aspiration, PCD, autoimmune
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Central: ABPA