Plugs vs nodules vs cavitations

Hi there,

This interactive by Insmed explains 'nodules' and cavitary BE really well which are a mass of macrophages that have been deployed by the body to fight off infection.

Insmed Interactive: https://www.aboutntm.com/inside-the-lung-damage/

Click on 'Deep Dive' because it goes into more detail and there are some videos throughout.

As to whether nodules turn into cavities, I'm not sure how that works, but not nodules don't necessarily turn into cavities.

The distinction between nodules and 'plugs' seen on a CT scan is a great question and would be interested to hear how radiologists characterize each or differentiate between the two. I suppose if it's a 'tree and bud' formation, the bud might be the nodule and the tree branch might be visualized as the opaque areas impacted by mucus plugs or sputum.

I have looked at a lot of lung CTs recently but don't remember having
seen "plugs" .
Or nodules in the context of bronchiectasis.

I read about
cylindrical (tubular) bronchiectasis (45%)
cystic bronchiectasis (most common in children) (45%)
varicose bronchiectasis (10%)
multiple types (25%)
[tension bronchiectasis] which some say should not count as bronchiectasis

but not about
"nodular bronchiectasis" and "cavitational bronchiectasis"

it's about the bronchii, which are "cavities" anyway, they are dark on CT.
The walls can be thickened then they show white on CTs

I'd like to see on CTs plugs or all that mucus being coughed up here.
Where is it ? Presumably in the (widend) distant bronchioles

ok, at lung.org I find :
-----------------
There are two forms of NTM lung disease. The less progressive form is sometimes called
nodular bronchiectasis. The NTM infection causes inflammation of the airways,
which over time causes them to become damaged and scarred.
As the disease progresses, the damaged airways lose their ability to clear mucus normally,
which invites recurring respiratory infections like bronchitis and pneumonia.
Nodular bronchiectatic NTM disease is found most often in older women who have
no smoking history.
----------------------
The other more progressive form of NTM lung disease is called cavitary disease.
The NTM infection in the lungs causes scarring, fibrosis and the formation of cavities
or pits in the lung tissue. This damage can lead to respiratory failure.
This form is most commonly found in people with a smoking history who also have
existing lung disease such as COPD or bronchiectasis.
--------------------------------

so, this terminology exists in USA , where NTM (non-tuberculous microbacteria)
is so common. It's not really bronchiectasis, which is a widening of the bronchii.
It's more like a classifiction of NTM, which often leads to bronchiectasis.

So, I'm wondering ... is the airway-clearance which is so much being talked
about here, importantant only for NTM or also for "normal" European
bronchiectasis ?

Let's tackle this question first, "So, I'm wondering ... is the airway-clearance which is so much being talked about here, importantant only for NTM or also for "normal" European
bronchiectasis?"

Airway clearance is important in bronchiectasis to help prevent NTM, pseudomonas, or any of the other infections that like to inhabit compromised lungs. In fact, although it was first practiced mainly in Cystic Fibrosis patients, and more recently in Bronchiectasis patients, pulmonologists are beginning to realize it is effective for people with COPD as well. See this informative Webinar by a world expert in NTM/Bronchiectasis:

While it is true that not every person with NTM has Bronchiectasis, most have it or COPD. To be clear, NTM is NOT as USA disease - it exists worldwide. Until recently, and maybe even today, it is underdiagnosed because it is rare - fewer than 1 in 1000 people has it in the US, and it looks like many other lung infections. Here is a report looking at global studies of NTM:
https://pmc.ncbi.nlm.nih.gov/articles/PMC6670190/
Usually people are treated repeatedly with antibiotics for pneumonia or bronchitis, often until a sharp-eyed radiologist sees evidence of NTM or bronchiectasis on an x-ray and the proper tests are done to reach a correct diagnosis. As Europe and Asia "catch up" to the US in recognizing the symptoms and doing lab testing, it is expected their rates will be similar to the USA and Canada.

Finally, it doesn't matter whether the disease is described as nodular NTM, cavitary NTM or Bronchiectasis, we are here to talk about the best way to manage it, to live our best possible lives in spite of it.

Have you been diagnosed with NTM, Bronchiectasis or both? Did you ever find an expert pulmonologist to treat you in Germany or nearby?

Thanks for the video. Lots of valuable info, including this quote: "Airway clearance is an investment in your future.”

Sue, NTM in bronchiectasis (BE) is 8% worldwide, 50% in USA.
[111] From the German BE-guidelines, 109 pages,540 refs, Feb.2024, quoting
Zhu et.al. 2021.
https://register.awmf.org/assets/guidelines/020-030l_S2k_Bronchiektasen_2024-06_1.pdf
it's in German but most refs are in English, so I recommend it here.
Airwau clearance is only covered in 8.2 among many other things
but they stress the importance.
Doctors recomment/prescribe saline airway clearance for BE
38% in Germany , 7% in UK
-----------------------
as for MAC-CTs - they look quite different, so I think I can't contribute
in this thread.
-----------------------
as for my case - I'll make a new thread later. The pulmologist looked at the CTs, panicked because of a pneumothorax on both sides and
immediately sent my to the lung clinic, where they did blood analysis
radiographs, questioning - and sent me home. I'm quite atypical
with all sorts of findings on the CTs but no etiology.
I'm studying other CTs which I find on the web but find none as mine.
I'll probably go to the BE-expert-center at MHH in Hannover but they
have 6 months waiting time.