Bronchiectasis Diagnosis: Tests, CT Findings, and Patient Stories
Bronchiectasis is usually diagnosed based on symptoms, medical history, and a chest CT scan. Additional testing, including sputum cultures, blood tests, and lung function testing, can help identify infections, assess lung function, and investigate the underlying cause.
Ask ten people living with bronchiectasis how they were diagnosed, and you may hear ten very different stories. I know I have. Over the past seven years, I’ve worked with hundreds of people living with bronchiectasis, and I’ve heard so many variations of the diagnosis story.
For some, it started with a chronic cough that would ’t go away. Others had years of bronchitis, recurrent pneumonia, and respiratory infections before anyone discovered they had bronchiectasis. Some had even been treated for asthma or COPD for years before a doctor took another look and discovered there was something else going on.
Then there are the completely unexpected diagnoses. Someone coughs up blood or gets a CT scan for an entirely different reason, and doctors find bronchiectasis incidentally. There really is no single path that leads someone to this diagnosis.
Chronic Cough and Bronchiectasis
A chronic cough, especially one that produces sputum, is a common symptom that can eventually lead to a bronchiectasis diagnosis. A chronic cough generally lasts eight weeks or longer, but some people with bronchiectasis cough for months or even years before getting the right diagnosis.
A persistent cough can have many causes, including asthma, allergies, postnasal drip, reflux, respiratory infections, and COPD. So it makes sense that a healthcare provider might investigate some of these more common explanations first. But what happens when the cough doesn’t go away? That’s when it may be time to keep looking, particularly if you’re also regularly bringing up sputum or having repeated respiratory infections.
Not everyone with bronchiectasis has exactly the same symptoms. Some people bring up sputum every morning, others produce mucus throughout the day, and some produce very little or none. Recurrent chest infections, repeated bouts of bronchitis or pneumonia, wheezing, shortness of breath, fatigue, and sometimes coughing up blood can also be part of the picture.
None of these symptoms alone can tell you you have bronchiectasis. To actually see what is happening inside the airways, you need imaging.
How Is Bronchiectasis Diagnosed?
A high-resolution chest CT scan is the key imaging test for confirming bronchiectasis in patients with symptoms and medical history. This matters because a standard chest X-ray doesn’t provide the same level of airway detail. Bronchiectasis may be visible on an X-ray when it is more extensive, but it can also be missed.
So what are they actually looking for on the CT scan? Normally, our bronchial tubes become progressively smaller as they branch outward toward the edges of the lungs. With bronchiectasis, that normal structure changes.
One clue is the airway’s size relative to the adjacent pulmonary artery. Normally, the airway should be a little smaller. With bronchiectasis, it may actually be larger. If you’ve ever seen the term bronchoarterial ratio in a CT report or while reading about bronchiectasis, they are referring to this airway-to-artery ratio.
This finding is sometimes called the signet ring sign because the dilated airway next to the smaller pulmonary artery resembles a ring with a stone in cross-section. They also look at whether the airways taper normally. As an airway travels farther into the lung, it should gradually narrow. With bronchiectasis, they may remain abnormally wide.
Another clue is seeing airways unusually close to the outer edges, or periphery, of the lungs. The CT scan may also show mucus plugging or thickened airway walls. Put those clues together, and you begin to understand why CT scans are so important in diagnosing bronchiectasis.
There Can Be Gray Areas in Reading a CT Scan
Here’s another important thing to understand. Not every case of bronchiectasis jumps out on a CT scan. Some cases are very obvious, while others are much more subtle, especially when the bronchiectasis is mild or involves only certain areas of the lungs.
Gray areas can make interpretation tricky, which is why experience with bronchiectasis and airway disease matters. A radiologist or pulmonologist who sees bronchiectasis often may be better at recognizing subtle changes than someone who sees it less often.
What Other Tests Might I Have?
Finding bronchiectasis on a CT scan is important, but it’s only the beginning. Now there are more questions to answer. What’s going on in your lungs? Is there an infection? How well are your lungs functioning? And perhaps most importantly, why did you develop bronchiectasis in the first place?
That’s where other testing comes in. Sputum cultures are an important part of evaluating bronchiectasis. They can identify bacteria, fungi, and nontuberculous mycobacteria, including MAC, that may be present in damaged airways.
Pulmonary function testing can help your medical team understand how well your lungs are working. Depending on your history, symptoms, and CT findings, your doctor may also recommend blood tests and other specialized tests. Not everyone needs the same tests. Like so much else with bronchiectasis, the evaluation should be individualized.
My Bronchiectasis Diagnosis Story
My story began when I came home from a European vacation with a cold. Not a big deal; we’ve all had colds. But this one was different because the cough wouldn’t go away.
I coughed all day long for weeks, and after about two months, I finally saw my internist. We thought reflux might be the culprit, so I did what I tend to do when I’m trying to solve a problem: I started reading everything I could about reflux.
I spent the next several months taking lots of reflux precautions and also tried medication. Nothing helped, and the cough just kept going. After several more months, I went back to my doctor, and this time she ordered a chest CT scan. That’s when I first heard the word bronchiectasis.
I had never heard this crazy word before. In fact, when my doctor said it, I thought she was mispronouncing bronchitis. It’s funny how, during a stressful moment, our brains sometimes try to turn unfamiliar information into something we already understand.
But she wasn’t saying bronchitis. She was saying bronchiectasis, and that was the beginning of my journey living with the disease. My next stop was a pulmonologist.
So Many Different Paths to a Bronchiectasis Diagnosis
Since then, I’ve heard hundreds of stories from other people living with bronchiectasis. No two are exactly alike, but a few types of diagnosis stories have always stood out to me. They also show why I think greater awareness of bronchiectasis matters.
Years of Bronchitis and Recurrent Pneumonia
I’ve talked with people who seem to have spent a good part of their lives dealing with respiratory problems. Bronchitis again and again. Recurrent pneumonia. Chronic coughing. Antibiotics, another infection, and then more antibiotics. And yet bronchiectasis was never identified.
Some of these people had many chest X-rays along the way, but no one ordered the CT scan that ultimately revealed what was happening in their airways. I find this especially interesting because of my own history. After I was diagnosed, I looked back at chest X-rays I’d had over approximately 20 years, and not one of those reports mentioned bronchiectasis.
Does that mean I didn’t have bronchiectasis then? Maybe. Maybe not. Those old X-rays simply can’t tell me that.
I’ve heard similar stories from so many other people. For some people, the diagnosis feels as though it came out of nowhere. But once they look back at their respiratory history, they can’t help but wonder whether bronchiectasis has been part of their story for much longer.
When You’ve Been Told It’s Asthma or COPD
I’ve heard another diagnosis story more than once. Someone has been told they have asthma or COPD and spends years treating it. They use inhalers, take medications, and do what they’ve been told to do, but the chronic cough is still there.
Maybe they’re still producing a lot of sputum or having repeated respiratory infections. Something just doesn’t seem to add up. Then, for whatever reason, they see a different doctor. Maybe they switch insurance companies and have to find a new doctor. Maybe they move, their longtime doctor retires, or they simply decide it’s time for another opinion.
The new doctor hears the same history but looks at it differently. This doctor may be more familiar with bronchiectasis and wonder whether the persistent cough, sputum, and recurrent infections suggest something more. The doctor orders a CT scan, and it reveals bronchiectasis.
That doesn’t necessarily mean the original asthma or COPD diagnosis was wrong. Bronchiectasis can exist along with asthma or COPD. But sometimes bronchiectasis is an important piece of the puzzle no one had identified before.
I think this message matters. If you’ve been treated for years and the treatment isn’t helping as expected, or your symptoms don’t quite seem to fit the diagnosis, it may be worth asking: Could something else be going on?
Bronchiectasis Found by Accident
Some people discover bronchiectasis when they aren’t being evaluated for a lung problem at all. One example I’m hearing more about involves a coronary artery calcium scan, sometimes called a calcium scoring test. This CT scan detects calcium deposits in the coronary arteries and helps assess cardiovascular risk.
Although the test focuses on the heart, it may also show portions of the lungs. Sometimes the radiologist notices something in the lungs that wasn’t the reason for the scan and mentions findings suggestive of bronchiectasis in the report. That’s what we mean by an incidental finding: something is discovered while you’re being tested for something completely different.
You go in for a test because you want information about your heart, and you come out with a report mentioning a lung disease you’ve possibly never even heard of. For some people, that’s the beginning of their bronchiectasis journey.
When the First Sign Is Coughing Up Blood
Some diagnosis stories are much more frightening. One that has always stayed with me involved someone who was on a plane, heading to Aruba for vacation, when she suddenly began coughing up blood. Can you imagine?
Coughing up blood, called hemoptysis, can occur with bronchiectasis. An episode like this may lead to a CT scan and additional testing, which can ultimately uncover bronchiectasis.
Always discuss coughing up blood with a healthcare professional promptly. Seek urgent medical care for a large amount of blood, breathing difficulty, chest pain, dizziness, or rapidly worsening symptoms.
What strikes me about a story like this is how quickly life can change. You’re on an airplane heading off on vacation, and suddenly you’re dealing with something frightening that leads you into a medical world you never expected to enter.
Her path to diagnosis was very different from mine. I started with a cold and a cough that wouldn’t go away. She started by coughing up blood on an airplane. Yet both paths eventually led to the same diagnosis.
The Bronchiectasis Diagnosis Is Only the Beginning
Once a CT scan identifies bronchiectasis, I believe one of the most important questions is also one of the simplest: Why do I have bronchiectasis?
This is something I didn’t understand when I was first diagnosed. Bronchiectasis isn’t always a single disease with a single cause. Many possible underlying causes and associated conditions exist, and figuring out which applies to you is an important part of the diagnostic process.
Depending on your history, your medical team may look at:
A history of serious or recurrent respiratory infections
Immune system problems
Aspiration or swallowing difficulties
Allergic bronchopulmonary aspergillosis (ABPA)
Primary ciliary dyskinesia
Cystic fibrosis or CFTR-related disorders
Autoimmune conditions
Alpha-1 antitrypsin deficiency
Other lung diseases
Sometimes, even after extensive testing, you still don’t get a clear answer about why you developed bronchiectasis. When appropriate evaluation doesn't identify an underlying cause, it’s called idiopathic bronchiectasis.
Living with Bronchiectasis Begins with Understanding It
When I first heard the word bronchiectasis, pronounced brong-kee-EK-tuh-sis, I knew nothing about the disease. Today, bronchiectasis is a huge part of my work and my life. I’ve spent years learning about the disease, talking with experts and, perhaps most importantly, listening to hundreds of people living with bronchiectasis tell me their stories.
If you’ve recently been diagnosed with bronchiectasis and are trying to figure out how you got here, I hope these stories help you see how many different paths can lead to the same diagnosis.
Getting the diagnosis is important, but in many ways, it’s only the beginning. When possible, evaluation at a center with bronchiectasis expertise can be especially helpful, especially if you are newly diagnosed or the underlying cause is unclear. A one-on-one consultation with me, Linda Esposito, can also help answer many of your questions and prepare you with targeted questions for a visit with your doctor.
Frequently Asked Questions
Can bronchiectasis be seen on a chest X-ray?
Sometimes, but only when the disease is more extensive. A standard chest X-ray often misses mild or early bronchiectasis, so a high-resolution CT scan is the standard test to confirm the diagnosis.
How long does it usually take to get diagnosed with bronchiectasis?
There’s no typical timeline. Some people are diagnosed within weeks of a persistent cough, while others live with symptoms, or a misdiagnosis of asthma or COPD, for years before a CT scan finally reveals bronchiectasis.
What is the bronchoarterial ratio, and what is the signet ring sign?
The bronchoarterial ratio compares the airway size to the pulmonary artery running alongside it on a CT scan. Normally, the airway is smaller than the artery; in bronchiectasis, it appears larger, creating the appearance radiologists call the signet ring sign.
What tests help find the underlying cause of bronchiectasis?
Beyond the CT scan that confirms bronchiectasis, doctors may order sputum cultures and blood tests, along with additional testing for conditions such as ABPA, primary ciliary dyskinesia, cystic fibrosis or CFTR-related disorders, autoimmune conditions, and alpha-1 antitrypsin deficiency, depending on a person’s history.
What does idiopathic bronchiectasis mean?
Idiopathic bronchiectasis means no underlying cause has been identified despite appropriate evaluation.
Is coughing up blood always a sign of bronchiectasis?
No, but coughing up blood (hemoptysis) can occur with bronchiectasis and should always be discussed promptly with a healthcare professional. Seek urgent medical care for a large amount of blood, breathing difficulty, chest pain, dizziness, or rapidly worsening symptoms.
Want to Learn More about Bronchiectasis?
The BE CLEAR® Guide to Bronchiectasis is designed to help you understand and manage your chronic lung condition at your own pace. Whether you’re newly diagnosed or looking to strengthen your daily routine, the guide offers expert-informed content, practical suggestions, and compassionate support every step of the way.
