A 56-year-old man presented with a 2-day history of fever and shortness of breath. He had a history of buccal cancer and received tracheostomy for maintenance of airway. Physical examination disclosed diffuse coarse crackles, especially over the left lower lung field.

Thick tenacious sputum was noted, and bronchoscopic examination performed for bronchial hygiene showed severe dilatation of left B7 (Figure 1A, arrow) and right B8 bronchus with copious purulent secretions. Chest computed tomography revealed dilatation of airways over bilateral lower lobes (Figure 1B, arrow) and confirmed a diagnosis of bronchiectasis. The patient was treated with antibiotics and chest physiotherapy, and made a good recovery.

Figure 1: A) Bronchoscopic examination and B) Chest computed tomography of bronchial hygiene.