Imaging of Small Airways Disease and Chronic Obstructive Pulmonary Disease

Imaging phenotypes of chronic obstructive pulmonary disease

“…CT helps categorize COPD into emphysema-predominant and airway-predominant forms (Figs. 1, 2) (7). The type of emphysema (ie, centrilobular, panlobular, paraseptal), the presence of bulla, and predominant location (ie, upper lung, lower lung, diffuse) are important features to be described ( Fig.…”

Thoracic Radiology

“…18-32), some cases of extrinsic versus intrinsic obstruction, 251 aspirated foreign objects, tracheobronchomalacia, and neoplasms (Video 18-11). 161,193,199,200,218,220,221,235,257 Abnormalities that can be diagnosed include (1) inflammatory forms of bronchiolitis, such as cellular bronchiolitis (usually due to infection 257 Cryptogenic organizing pneumonia has been previously classified as a disease of the small airways but is now considered an idiopathic interstitial pneumonia. The ability to produce excellent quality three-dimensional images aids in the evaluation of subtle airway stenoses and complex airway lesions, particularly when they are oblique with respect to the imaging plane.…”

“…250 MS CT, with its ability to acquire images rapidly with equal resolution in all planes, is particularly useful in this assessment and can provide detailed three-dimensional analysis of the central airways (Video 18-11B). 161,235,257 The use of postexpiratory HRCT is particularly important in the diagnosis of small airway diseases because air trapping may be visible in the absence of other abnormalities (see eFig. In the assessment of tracheal and central bronchial neoplasms, CT does not substitute for bronchoscopy and biopsy, but it can be useful to determine the extent of invasion and to direct the bronchoscopist to a particular HRCT has the ability to demonstrate abnormalities of small airways having a diameter of a few millimeters or less.…”

Recent advances in the management of acute bronchiolitis

“…Other than a mosaic pattern of attenuation, which is highly suggestive of bronchiolitis obliterans, it is often difficult to distinguish severe asthma from bronchiolitis [70,71]. Cylindric bronchial dilation or bronchiectasis can be seen with constrictive bronchiolitis, particularly in cases related to transplantation, collagen vascular disease, inhalation of toxic fumes, and previous infection [72]. Subpleural distribution of patchy consolidation or ground glass density is a characteristic finding of proliferative bronchiolitis on HRCT.…”

“…A conservative approach to treatment seems adequate in the majority of children, especially for the youngest ones (<3 months) [21,22,72] and treatment is merely supportive. Clinical scoring systems have been proposed [62], but none have been formally accepted [44], although the New Zealand and Scotland guidelines have classified bronchiolitis into mild, moderate and severe (Table 2).…”