CT findings of bronchial dilation and a history of chronic productive cough in a young adult most strongly suggest which diagnosis?

• A. Asthma
• B. Bronchiectasis
• C. Chronic bronchitis
• D. Emphysema

Answer: (B)

Bronchiectasis is most likely. When CT shows dilation of the bronchi, especially in the setting of a long-standing productive cough, it reflects irreversible widening of the airways from chronic infection or obstruction. This dilation allows mucus to pool and perpetuates infection, producing the classic picture of a person with a chronic productive cough and recurrent respiratory infections. On CT you may see bronchi that are larger than normal, thickened airway walls, and lack of normal tapering toward the periphery—the so-called airway dilation signs. This pattern is not typical of asthma, which centers on reversible airway obstruction; chronic bronchitis tends to show bronchial wall thickening and mucus production without true bronchial dilation; and emphysema involves destruction of alveolar walls with low-attenuation areas on CT rather than primary bronchial dilation.