A 55-year-old man with a 30 pack-year smoking history presents with progressive dyspnea, chronic productive cough with copious purulent sputum, and recurrent hemoptysis. HRCT shows bronchial wall dilation with 'signet ring' sign and 'tram-track' opacities in the lower lobes. What is the most likely diagnosis?
- A Chronic obstructive pulmonary disease
- B Bronchiectasis ✓
- C Cystic fibrosis
- D Allergic bronchopulmonary aspergillosis
Correct answer: B. Bronchiectasis
Explanation
Bronchiectasis presents with chronic productive cough, purulent sputum, recurrent infections, and hemoptysis. HRCT shows bronchial dilation (signet ring sign: dilated bronchus adjacent to pulmonary artery), tram-track lines (thickened bronchial walls), and lack of bronchial tapering. COPD does not cause this degree of sputum production or tram-track opacities.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.