Bronchiolitis obliterans or constrictivebronchiolitis - Thoracic Imaging

Title: Thoracic Imaging - Bronchiolitis obliterans or constrictivebronchiolitis
Diagnosis: Bronchiolitis obliterans or constrictivebronchiolitis
Author: Martins Martina
Comment: Howarth Nigel
Hospital: HUG
Department: Département de Radiologie
State: Terminée
Date: 21.03.2003
: 3361
KeyWords: Bronchiolitis obliterans; COPD
Anatomy: Thorax
Chapter: Obstructive disease
ACR: 6.43

Clinical Presentation: History of ulcerative colitis and ankylosingspondylitis.
Exertional dyspnea.
Comment: Typical findings of bronchiolitis obliterans include aconcentric
narrowing of the bronchiolar lumen due to irreversiblesubmucosal and peribronchiolar
fibrosis. The condition starts withinflammation and epithelial rupture within the small
airways,followed by a proliferation of granulation tissue in thebronchiolar lumen leading to
complete or partial obstruction.Bronchiolar obstruction causes a hypoxia in the
hypoventilatedarea, which triggers a reflex vasoconstriction and expiratory airtrapping
responsible for the mosaic attenuation pattern.Bronchiolitis obliterans, also known as
constrictive bronchiolitis,can be caused by a viral infection in early childhood, a sequela
ofMycoplasma pneumoniae infection or toxic fume inhalation. It isalso seen in rejection
syndromes after a bone marrow transplant andin chronic rejection after lung or heart
transplants. It is acomplication of rheumatoid arthritis, especially after a treatmentwith
penicillamine. It is also associated with inflammatory boweldisease.
Description: High resolution CT shows a heterogeneous density ofthe lung
parenchyma with vascular structures of varying sizes,smaller in the areas of
hypoattenuation due to a mosaic perfusionpattern. Areas of hyperattenuation are relatively
overperfused.There is also bilateral bronchiectasis. End-expiratory images 4 and5: the
mosaic attenuation pattern caused by the airway obstructionis accentuated during forced
expiration due to air trapping inareas with bronchial obstruction.

Order: 0
Dislocation: 0
Polytrauma: 0
Open: 0
Pathologic: 0
Operation: 00.00.00
Graft: 0

References: American thoracic society/ European respiratorysociety.
International Multidisciplinary Consensus Classificationof the Idiopathic Interstitial
Pneumonias. Am J Respir Crit CareMed 2002;165:277-304. Hansell DM. Small airways
diseases: detectionand insights with computed tomography. Eur Respir
J2001;17:1294-1313. Mahadeva R, Walsh G, Flower CD, Shneerson JM.Clinical and
radiological characteristics of lung disease ininflammatory bowel disease. Eur Respir J
2000;15: 41-8. Karadag F,Ozhan MH, Akcicek E, Gunel O, Alper H, Veral A. Is it possible
todetect ulcerative colitis-related respiratory syndrome early?Respirology 2001;6:341-6.
Grenier PA, Beigelman-Aubry C, Fétita C,Prêtreux F, Brauner MW, Lenoir S. New frontiers
in imaging of theairways. Eur Radiol 2002; 12:1022-1044

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