Radiologic and Pathologic Features of Bronchiolitis
Sudhakar J. Pipavath1,2,
David A. Lynch3,
Carlyne Cool3,
Kevin K. Brown4 and
John D. Newell4
1 Department of Radiology, University of Washington, Seattle, WA.
2 Present address: Teleradiology Solutions, Bangalore, KA, India.
3 Department of Radiology, University of Colorado Health Sciences Center, 4200 E
Ninth Ave., Box A030, Denver, CO 80262.
4 National Jewish Medical and Research Center, Denver, CO.
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Fig. 1 —35-year-old man with cellular bronchiolitis secondary to
Mycoplasma infection. High-resolution CT image through left mid lung
shows multiple poorly defined centrilobular nodules, many of which connect to
branching linear structures (arrows), tree-in-bud pattern.
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Fig. 2 —57-year-old cigarette smoker with respiratory bronchiolitis.
High-resolution CT image shows diffuse fine poorly defined centrilobular
nodules (arrows) with more patchy ground-glass opacity
posteriorly.
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Fig. 3 —50-year-old American woman of Asian origin with
panbronchiolitis. High-resolution CT image of chest shows centrilobular
nodules with tree-in-bud pattern (arrowheads), bronchiolectasis
(arrow), and cylindric bronchiectasis.
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Fig. 4A —30-year-old man with postinfectious constrictive
bronchiolitis and history of Mycoplasma pneumonia. High-resolution CT
image of chest shows multiple patchy areas of low attenuation in both lungs.
Also note mild bronchial wall thickening and cylindric bronchiectasis.
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Fig. 4B —30-year-old man with postinfectious constrictive
bronchiolitis and history of Mycoplasma pneumonia. Expiratory
high-resolution CT image shows accentuation of areas of decreased attenuation,
confirming presence of air trapping.
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Fig. 5 —Photomicrograph of lung specimen in patient with
bronchiolitis shows histopathologic features of cellular bronchiolitis. Note
partial bronchiolar wall destruction with infiltration of neutrophils
(arrow). (H and E, x 200)
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Fig. 6A —62-year-old woman with Mycobacterium
avium-intercellulare infection and cellular bronchiolitis pattern. CT
images show tree-in-bud pattern (arrow, A;
arrowheads, B) consistent with cellular bronchiolitis.
Associated bronchiectasis and collapse of right middle lobe and lingula are
important clues to diagnosis of atypical mycobacterial infection.
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Fig. 6B —62-year-old woman with Mycobacterium
avium-intercellulare infection and cellular bronchiolitis pattern. CT
images show tree-in-bud pattern (arrow, A;
arrowheads, B) consistent with cellular bronchiolitis.
Associated bronchiectasis and collapse of right middle lobe and lingula are
important clues to diagnosis of atypical mycobacterial infection.
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Fig. 7 —Patient with hypersensitivity pneumonitis. Histopathologic
image of lung shows poorly formed peribronchiolar granuloma (arrow)
with chronic interstitial inflammation. (H and E, x 400)
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Fig. 8A —55-year-old man with cellular bronchiolitis secondary to
subacute hypersensitivity pneumonitis. High-resolution CT images through right
mid lung show diffuse ill-defined centrilobular nodules with patchy areas of
low attenuation (arrows, A), probably representing air
trapping.
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Fig. 8B —55-year-old man with cellular bronchiolitis secondary to
subacute hypersensitivity pneumonitis. High-resolution CT images through right
mid lung show diffuse ill-defined centrilobular nodules with patchy areas of
low attenuation (arrows, A), probably representing air
trapping.
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Fig. 9 —Patient with respiratory bronchiolitis. Histopathologic image
of lung shows multiple brown-pigmented macrophages (arrows) within
bronchiolar and alveolar space lumen. (H and E, x 400)
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Fig. 10 —40-year-old female cigarette smoker with respiratory
bronchiolitis–associated interstitial lung disease. High-resolution CT
image through right mid lung shows patchy ground-glass opacity with
centrilobular nodules (arrow).
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Fig. 11 —Patient with follicular bronchiolitis. Photomicrograph of
lung biopsy specimen shows lymphoid follicle (arrow) with germinal
center formation in bronchiolar wall. (H and E, x 200)
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Fig. 12 —37-year-old woman with rheumatoid arthritis and follicular
bronchiolitis. High-resolution CT image shows tree-in-bud pattern
(arrowhead) with a few larger nodules and occasional discrete small
thin-walled cysts (arrow).
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Fig. 13 —Photomicrograph of lung specimen of 67-year-old Asian woman
with panbronchiolitis shows severe transmural inflammation of bronchiole. (H
and E, x 200)
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Fig. 14 —Patient with bronchiolitis obliterans. Photomicrograph of
lung specimen shows abundant yellow-staining fibrous tissue within elastic
lamina of bronchiole, partially obliterating bronchiolar lumen. (pentachrome,
x 200)
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Fig. 15 —55-year-old woman with rheumatoid arthritis and bronchiolitis
obliterans. Expiratory high-resolution CT image through left upper lobe shows
patchy areas of air trapping. Note right upper lobe tracheal bronchus
(arrow).
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Fig. 16A —10-year-old girl with Swyer-James syndrome. Inspiratory
high-resolution CT image through lower lungs shows asymmetric decrease in lung
attenuation in lingula, associated with decreased size of pulmonary vessels
and cylindric bronchiectasis. There is mild patchy decrease in attenuation in
anterior right lung.
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Fig. 16B —10-year-old girl with Swyer-James syndrome. Expiratory
high-resolution CT image confirms extensive asymmetric air trapping.
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Fig. 17 —Constrictive bronchiolitis pattern in worker, in a microwave
popcorn-flavoring factory, who had severe obstructive lung disease. CT image
shows diffuse decrease in lung attenuation, with mild cylindric
bronchiectasis.
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Fig. 18 —Constrictive bronchiolitis pattern in 41-year-old male double
lung transplant recipient with bronchiolitis obliterans syndrome. CT image
shows bilateral diffuse cylindric bronchiectasis, with diffuse decrease in
vascularity, and decrease in lung attenuation.
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Fig. 19 —Constrictive bronchiolitis pattern in patient with pulmonary
neuroendocrine cell hyperplasia. High-resolution CT image shows mosaic
attenuation, which is more marked on right than on left.
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Copyright © 2005 by the American Roentgen Ray Society.
