Radiographic Features of Persistent Pneumonia and Cystic Bronchiectasis in Bronchiectasis-Copd Overlap Syndrome : A Case Report

Background: Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory condition characterized by persistent airflow obstruction and respiratory symptoms that may impair breathing. Bronchiectasis-COPD Overlap Syndrome (BCOS) is a distinct clinical phenotype associated with greater symptom severity, more frequent chronic bronchial infection, and poorer prognosis than COPD alone. Case: This is a case of a 55-year-old male with a 20-year smoking history who presented with a COPD exacerbation characterized by worsening dyspnea, productive cough, tachypnea, and hypoxemia; chest radiograph showed pneumonia with emphysematous lung. Over two years of follow-up, serial chest radiographs demonstrated persistent pneumonia, progressive cystic bronchiectasis honey-comb like appearance, and emphysematous lung with additionally showing bilateral pulmonary artery dilation suggestive of pulmonary hypertension. Sputum culture isolated Staphylococcus aureus. Patient received sequential long-acting bronchodilator (LAMA/LABA) therapy, inhaled corticosteroids, and maintenance antibiotics, but still has not demonstrated a significant change in clinical response. Discussion: The persistent respiratory symptoms of BCOS are best explained by the "vicious vortex" concept, in which structural airway damage from COPD and bronchiectasis impairs mucociliary clearance, promoting chronic bacterial colonization, neutrophilic inflammation, and further airway destruction; chronic S. aureus infection and biofilm formation likely sustained this cycle. Chest radiograph showed cystic bronchiectasis honey-comb like appearance but it has limited sensitivity compared to high-resolution computed tomography (HRCT) Conclusion: This case underscores the high morbidity associated with BCOS and highlights the need for a multidisciplinary approach combining bronchodilator optimization, targeted infection control, and cardiovascular monitoring, with HRCT considered when plain-film radiography findings are inconclusive.