45-year-old presents with persistent productive cough and clubbing. On auscultation, wheeze and crackles are present. Which is the most specific investigation to confirm the diagnosis?
HRCT
Bronchoscopy with bronchoalveolar lavage
Chest X-ray
MRI
Ans. a. HRCTPersistence of a productive cough, clubbing, wheeze, and crackles is suggestive of bronchiectasis. HRCT is the diagnostic procedure of choice (most specific).HRCT findings in bronchiectasis:Airway dilation (detected as parallel "tram tracks" or as the "signet-ring sign").Lack of bronchial taperingBronchial wall thickening in dilated airwaysInspissated secretions (e.g., the "tree-in-bud" pattern)Cysts emanating from the bronchial wall (especially pronounced in cystic bronchiectasis)