대한흉부영상의학회 Weekly Chest Cases

Case No : 321 Date 2003-12-20

Courtesy of Yeon Joo Jeong, M.D., Kyung Soo Lee, M.D. / Samsung Medical Center, Seoul, Korea
Age/Sex 19 / F
Chief ComplaintProductive cough

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Diagnosis With Brief Discussion

Diagnosis: Diffuse panbronchiolitis
Radiologic Findings: Plain chest radiograph shows diffuse small nodules with mid- and lower lung zones predominancy, associated with mild overinflation. Thin-section CT scans obtained through both lower lobes show small centrilobular nodules, branching linear opacities and brochiolectasis.
Brief Review: Diffuse panbronchiolitis is a disese of unknown etiology and pathogenesis associated with chronic inflammation of the paranasal sinuses and respiratory bronchioles. The latter is characterized histologically by luminal obliteration and a sriking accumulation of foamy macrophages in the walls of bronchioles, alveolar ducts, and adjacent parenchyma. The disease has been recognized almost exclusively in Japan and South Korea.

Radiographic abnormalities consist of diffuse nodules smaller than 5 mm in diameter and mild to moderate hyperinflation. The findings on HRCT are characteristic and include small centrilobular nodules and branching linear opacities, bronchiolectasis, bronchiectasis, and mosaic areas of decreased parenchymal attenuation. The presence of these findings is related to the stage of the disease: the earliest manifestation consists of centrilobular nodular opacities, followed by branching linear opacities that connect the the nodules, followed by thick-walled, centrilobular lucencies. These findings have been shown to correspond, respectively, to bronchiolar wall and peribronchiolar inflammation and fibrosis, bronchiolar dilatation with the presence of intraluminal secretions, and dilated air-filled bronchioles. Late manifestations of the disease include large, cystic spaces; bullae; and evidence of air trapping with large lung volumes and decreased attenuation of peripheral lung parenchyma
References: Muller NL, Fraser RS, Lee KS, Johkoh T. Bronchiolitis. In: John JR, ed. Diseases of the Lung. 1st ed. Philadelphia, PA: LWW, 2003; 298-300
Keywords: Lung, Non-infectious inflammation,

No. of Applicants : 25

▶ Correct Answer : 18/25, 72.0%

- Annecy Hospital, France Gilles Genin
- CH Lyon sud, France Xavier Riviere
- CHU Nancy-Brabois, France Denis Regent
- Chungju Hospital, Konkuk University, Korea Chang Hee Lee
- CIM Saint Dizier, France JC Leclerc
- Dong-A University Hospital, Korea Ki-Nam Lee
- Ewha Women's University Hospital, Korea Yookyung Kim
- Geoje Baek Hospital , Gyungnam, Korea James Lim
- Hangang SacredHeart Hospital, Korea Eil Seong Lee
- Incheon Sarang Hospital, Korea Jung Hee Kim
- Korea University Anam Hospital, Korea Bo Kyung Je
- Kyunghee University Hospital, Korea Kyung Ran Ko
- Mallinckrodt Institute of Radiology, USA Jin Mo Goo
- Seoul National University Hospital, Korea Eun-Ah Park
- Social Security Hospital, Ankara, Turkey Meric Tuzun
- Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate
- Tokyo Kouseinenkin Hospital , Japan Noriatsu Ichiba
- Upasana Hospital, Kollam, India Joy A Thomas

▶ Semi-Correct Answer : 3/25, 12.0%

- Centre d'imagerie Jacques Callot, Nancy, France Lionel Cannard
- Ev. Krkhs. Hubertus, Berlin, Germany Michael Weber
- Homs National Hospital, Homs, Syria Rami Abou Zalaf

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 321 Date 2003-12-20

Discussion

No. of Applicants : 25