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8/7/2019 journal ppt

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Respiratory Bronchiolitis

High-resolution CT: ill-defined centrilobular

nodules; Small patches of ground-glass

opacity; may predominate in the upper lobes


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Fig. 257-year-old cigarette smoker with respiratorybronchiolitis. High-resolution CT image shows diffuse finepoorly defined centrilobular nodules (arrows) with morepatchy ground-glass opacity posteriorly.


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Respiratory

BronchiolitisAssociated Interstitial Lung

Disease Severe symptoms than respiratory

bronchiolitis and causes impairment of lung

function and gas exchange

patchy areas of ground-glass opacity and air

trapping are usually present


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Fig. 1040-year-oldfemale cigarettesmoker withrespiratorybronchiolitisassociated interstitial

lung disease. Highresolution CT image

through right midlung shows patchy

groundglass opacitywith centrilobular

nodules (arrow).


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Imaging Differential DiagnosisD

esquamative Interstitial Pneumonia Less common centrilobular nodules;ground-glass opacity of respiratory

bronchiolitisassociated interstitial

lung disease is patchier and poorly

defined

Nonspecific Interstitial Pneumonia ground-glass opacity is usually morediffuse and is commonly associated with a

reticular abnormality

Hypersensitivity pneumonitis centrilobular nodules and ground-glassopacity are usually more diffuse; most

patients are nonsmokers


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Follicular Bronchiolitis

characterized by lymphoid hyperplasia of

bronchus-associated lymphoid tissue (BALT)

Histology: presence of hyperplastic lymphoidfollicles with reactive germinal centers

distributed along the bronchioles and, to a

lesser extent, the bronchi

Lymphocytes are polyclonal on

immunohistochemistry


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Follicular Bronchiolitis

Most cases of follicular bronchiolitis areassociated with collagen vascular diseases,particularly rheumatoid arthritis and Sjgrens

syndrome High-resolution CT: centrilobular and

peribronchial nodules, most being around 3 mmin size, but ranging from 1 to 12 mm; tree-in-bud

pattern may be present; Areas of ground-glassopacity and rarely bronchial dilatation andinterlobular septal thickening may also be seen


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Fig. 1237-year-old

woman with

rheumatoid arthritis

and follicular

bronchiolitis. High-

resolution CT imageshows tree-in-bud

pattern (arrowhead)

with a few larger

nodules and occasionaldiscrete small thin-

walled cysts (arrow).


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Diffuse Panbronchiolitis

unique entity of unknown cause that is seen

mainly in Asia, especially Japan and Korea

typically affects middle-aged men and has norelationship to smoking

associated with the human leukocyte antigen

genotype Bw54 in more than 60% of the cases

Progressive cough, dyspnea, and severe

pansinusitis are seen


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Diffuse Panbronchiolitis

Treatment: Long-term lowdose erythromycin isrecommended

Histology: transmural inflammatory nodules are

composed of mononuclear cells centered on therespiratory bronchioles; Foamy macrophages arepresent in the interstitium around thebronchioles and within the alveoli

High-resolution CT: centrilobular opacities withbranching lines (tree-in-bud pattern),bronchiolectasis, and bronchiectasis; basal andperipheral lung predominance


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Fig. 350-year-old

American woman of

Asian origin withpanbronchiolitis.

High-resolution CT

image of chest shows

centrilobular nodules

with tree-in-bud

pattern (arrowheads),

bronchiolectasis(arrow), and cylindric

bronchiectasis.


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Bronchiectasis

Signs of inflammatory and fibrotic

bronchiolitis are frequently seen in patients

with bronchiectasis of any cause, including

cystic fibrosis, immune deficiency, and

previous infection, presumably because the

pathologic process involving the bronchi has

also involved the small airways.

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