대한흉부영상의학회 Korean Society of Thoracic Radiology GuerBet

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대한흉부영상의학회 Weekly Case 검색
대한흉부영상의학회 Weekly Case 검색
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Weekly Chest CasesArchive of Old Cases

Case No : 9 Date 1997-12-29

  • Courtesy of Jae-Woo Song, M.D., Jung-Gi Im, M.D. / Boramae Hospital, Seoul National University Hospital
  • Age/Sex 22 / F
  • Chief Complaintchronic cough, sputum, and sinusitis for several years
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Diffuse Panbronchiolitis (DPB)
Radiologic Findings
Brief Review
Diffuse panbronchiolitis is a disease of unknown etiology and pathogenesis characterized by chronic inflammation of respiratory bronchioles with secondary obstructive effects.
Pathologically DPB is characterized by thickening of the walls of terminal and respiratory bronchioles by lymphocytes, plasma cells, and histiocytes. Intramural fibrosis may be present and, in combination with the mural infiltrate, results in significant airway narrowing. Apart from hyperinflation and the accumulation of lipid-laden macrophages distal alveolar ducts and lung parenchyma are usually normal.

The changes are more or less diffuse throughout the lungs resulting in roentgenographic evidence of a disseminated nodular pattern with lower zonal predominance. Evidence of hyperinflation is also present. HRCT can show four types of opacities: 1) small nodules around the end of bronchovascular branchings, 2) small nodules in the centrilobular area connected with small branching linear opacities, 3) nodules accompanied by small ductal opacities connected to proximal bronchovascular bundles, and 4) large cystic opacities accompanied by dilated proximal bronchi.

Most patients are between 30 and 60 years of age; the male ro female ratio is approximately 2 to 1. The chief clinical manifestations are dyspnea on exertion and cough, often with sputum production. Sinusitis is common. In the late stages, sputum culture often reveals the presence of microorganisms, especially P. aeruginosa, suggesting the development of airway colonzation. Pulmonary function tests show marked obstructive and mild restrictive impairment. Arterial hypoxemia is common.
References
Keywords
Airway, Lung, Non-infectious inflammation, Bronchiolitis,

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