Post-infectious bronchiolitis obliterans: clinical, radiological and pulmonary function sequelae

Abstract

Background. There are few data on clinical, chest radiograph (CXR) or pulmonary function sequelae in children with post-infectious bronchiolitis obliterans (BO) (pulmonary crepitations, abnormalities on CXR, CT, nuclear medicine scans, or bronchography, with a history of past pulmonary infection and in the absence of other underlying pathology). Objective. To analyse the methodology of diagnosis, long-term clinical imaging and pulmonary function sequelae of post-infectious BO in children. Materials and methods. Imaging (CXRs, CT and nuclear lung scans) and clinical histories of 19 children were analysed. Results. Clinical follow-up (mean 6.8 years), revealed a high incidence of continuing problems (asthma and bronchiectasis). Fixed airway obstruction was the most common pulmonary function sequela. The sequelae on follow-up (mean 5.8 years) CXR were classified into five patterns which are illustrated: unilateral hyperlucency of an enlarged lung/part of lung; complete collapse of the affected lobe; unilateral hyperlucency of a small or normal-sized lung; bilateral hyperlucent lungs and a mixed pattern of persistent collapse, hyperlucency and peribronchial thickening. Conclusion. Long-term observations in children with post-infectious BO should be undertaken to detect bronchiectasis and obstructive airway disease. Sequelae evident on CXR, other than those previously described, can be found. Bronchography and/or lung biopsy are not usually required for the diagnosis of post-infectious BO.

Bronquiolite obliterante: perfil clínico e radiológico de crianças acompanhadas em ambulatório de referência

“…Open pulmonary biopsy, the criterion standard, is currently not used to diagnose BO because it is invasive, poses greater chances of complications and may lead to inconclusive results. The distribution of pulmonary disease is heterogeneous and there may be no clinical or radiological correlation with the specimen examined by the pathologist (4,14,15) .…”

Post-infectious bronchiolitis obliterans in children

“…18 e Streptococcus pneumoniae 19 ) e germes atípicos (Mycoplasma pneumoniae 20 ). A infecção por micoplasma, em algumas séries, corresponde à segunda etiologia mais frequente, chegando a 26% dos casos 19,21 .…”

“…A hiperlucência uni ou bilateral parece ser um achado consistente 21,28,40 e já foi descrita em até 50% dos casos 19 . Atelectasias persistentes já foram encontradas em até 30% dos casos 18 .…”

“…É consenso que o diagnostico da BOPI pode ser realizado, com boa margem de segurança, com base nos achados clínicos e exames complementares não invasivos 5,18,19,21,29 . Não há um achado que seja específico para BOPI, entretanto, quando correlacionada com o quadro clínico, a TCAR do tórax é o exame mais indicado para o diagnóstico de BOPI.…”

“…Não há um achado que seja específico para BOPI, entretanto, quando correlacionada com o quadro clínico, a TCAR do tórax é o exame mais indicado para o diagnóstico de BOPI. Isso porque a TCAR fornece informações sobre lesões brôn-quicas ou de pequenas vias aéreas 21 por ser mais sensível que a radiografia de tórax e que a cintilografia pulmonar na detecção das anormalidades da via aérea e do parênquima que ocorrem na BOPI.…”