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Psyllium Aspiration Causing Bronchiolitis

Radiographic, High-Resolution CT, and Pathologic Findings

¹ Department of Radiology and Diagnostic Imaging, Division of Thoracic Imaging, University of Alberta Hospital, 8440-112 St., Edmonton, Alberta, T6G 2B7 Canada
² Department of Laboratory Medicine and Pathology, University of Alberta Hospital, Edmonton, Alberta, T6G 2B7 Canada.
³ Department of Medicine, Division of Pulmonary Medicine, University of Alberta Hospital, Edmonton, Alberta, T6G 2B7 Canada.

View larger version (149K): [in a new window]   Fig. 1A. —48-year-old woman who aspirated psyllium granules. Posteroanterior chest radiograph shows predominantly nodular interstitial abnormality with bibasilar distribution.

View larger version (131K): [in a new window]   Fig. 1B. —48-year-old woman who aspirated psyllium granules. Targeted high-resolution CT scan at level of lower right hilum reveals centrilobular pattern of well-defined nodules, several of which are arranged in "tree-in-bud" pattern (arrow).

View larger version (138K): [in a new window]   Fig. 1C. —48-year-old woman who aspirated psyllium granules. Photomicrograph shows pulmonary artery (curved arrow) and accompanying bronchiole (short straight arrow) with partial obliteration of airway lumen by granulomatous inflammation (long straight arrow). Granulomatous inflammation is restricted to small airways without significant involvement of alveoli. (H and E, x80)

View larger version (131K): [in a new window]   Fig. 1D. —48-year-old woman who aspirated psyllium granules. Photomicrograph shows granulomatous inflammation. Note multiple foreign body-type multinucleated giant cells. One giant cell contains foreign material within cytoplasm (arrow). (H and E, x520)

View larger version (71K): [in a new window]   Fig. 1E. —48-year-old woman who aspirated psyllium granules. High-resolution CT scan at level of pulmonary hilum obtained 14 months after aspiration of psyllium granules shows slight decrease in profusion of centrilobular nodules. Note that mosaic perfusion has developed in interval.

View larger version (46K): [in a new window]   Fig. 1F. —48-year-old woman who aspirated psyllium granules. Inspiratory (F) and expiratory (G) CT scans at lung base show that, on G, geographic areas of air trapping have developed. Air trapping is consistent with moderately extensive small airways disease and possibly constrictive bronchiolitis.

View larger version (58K): [in a new window]   Fig. 1G. —48-year-old woman who aspirated psylliun granules. Inspiratory (F) and expiratory (G) CT scans at lung base show that, on G, geographic areas of air trapping have developed. Air trapping is consistent with moderately extensive small airways disease and possibly constrictive bronchiolitis.

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