Obliterative Bronchiolitis

Abstract

Obliterative bronchiolitis (OB) is a condition characterized by inflammation and fibrosis of the bronchiolar walls resulting in narrowing or obliteration of the bronchiolar lumen. The most common causes are childhood lower respiratory tract infection, hematopoietic stem cell or lung and heart-lung transplantation, and toxic fume inhalation. The most frequent clinical manifestations are progressive dyspnea and dry cough. Pulmonary function tests demonstrate airflow obstruction and air trapping. Radiographic manifestations include reduction of the peripheral vascular markings, increased lung lucency, and overinflation. The chest radiograph, however, is often normal. High-resolution CT is currently the imaging modality of choice in the assessment of patients with suspected or proven OB. The characteristic findings on high-resolution CT consist of areas of decreased attenuation and vascularity (mosaic perfusion pattern) on inspiratory scans and air trapping on expiratory scans. Other CT findings of OB include bronchiectasis and bronchiolectasis, bronchial wall thickening, small centrilobular nodules, and three-in-bud opacities. Recent studies suggest that hyperpolarized 3 He-enhanced magnetic resonance imaging may allow earlier recognition of obstructive airway disease and therefore may be useful in the diagnosis and follow-up of patients with OB.

Constrictive bronchiolitis in diffuse idiopathic pulmonary neuroendocrine cell hyperplasia

“…Similarly, in a study of 30 patients with DIPNECH, 86% of whom manifested airflow obstruction, CB was observed in only 8 (44%) of the 18 examined biopsies [ 10 ]. This finding can be explained by the patchy nature of CB, which may have limited its identification upon histological examination [ 21 ]. However, the comparable frequency of CB among patients with and without airflow obstruction in our study (53% versus 44%, respectively; p=0.58), and the bronchodilator responsiveness, an unusual finding in CB [ 22 ], in some patients suggest that pathophysiological mechanisms other than CB contribute to airflow obstruction in DIPNECH.…”

Bronquiolite obliterante em paciente pediátrico associada com exposição à cocaína e outras drogas de abuso durante o período gestacional

“…A BO é caracterizada em achados radiográficos por inflamação e fibrose das vias aéreas com diâmetro < 2 mm. Na infância, ela tem um caráter predominantemente constrictivo (Garipo & Capelozzi, 2006;Silva & Müller, 2008;Lino et al, 2013;Callahan et al, 2019). No diagnóstico de BO, possíveis diagnósticos diferenciais devem ser levados em conta, tais como o refluxo gastroesofágico, fibrose cística, tuberculose pulmonar e deficiência de alfa-1-antitripsina.…”

“…Foi primeiramente descrita por Lange em 1901, em dois pacientes que se apresentavam com doença pulmonar idiopática. Na infância a BO cursa com remodelamento (fibrose) das pequenas vias aéreas após uma agressão que resulte em processo inflamatório agudo, levando à obstrução do fluxo aéreo (Garipo & Capelozzi, 2006;Lobo et al, 2007;Silva & Müller, 2008;Lino et al, 2013).…”

Constrictive Bronchiolitis in a Patient With Neurotuberculosis

“…Constrictive bronchiolitis, also known as bronchiolitis obliterans or cicatricial bronchiolitis, is a rare fibrotic condition, with involvement of terminal and respiratory bronchioles (1,2). This condition represents a pattern of injury to small airways, and can be caused by different etiologies such as post lung, heart or bone marrow transplant, as well as connective tissue diseases, post inhalation injury or lower respiratory tract infection.…”

“…(5) The most common symptoms are cough and dyspnea. The main imaging findings in chest computed tomography exams are the mosaic attenuation pattern and the presence of bronchiectasis and/or bronchial parietal thickening, inferring a bronchiolocentric pattern of involvement (1). The presence of centrilobular nodules is a finding less commonly described in the literature.…”