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Weekly Chest CasesArchive of Old Cases

Case No : 553 Date 2008-06-02

  • Courtesy of Woon Jung Kwon, MD. / Ulsan University Hospital, South Korea
  • Age/Sex 30 / F
  • Chief ComplaintMild dyspnea for 2 years / Pulmonary Function Test: Mild restrictive ventilatory defect
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7

Diagnosis With Brief Discussion

Diagnosis
Idiopathic Bronchiolocentric Interstitial Pneumonia ( Bronchiolocentric fibrosis )
Radiologic Findings
* CXR
- Ill-defined tiny nodular opacities in both lungs

* Chest CT
- Extensive ill-defined tiny centrilobular nodules in both lungs
- Previous CT findings (2007-6-5) also show similar lesions without definite change of extent

* Differential Diagnosis
- Including diseases, which CT findings show extensive distributed centrilobular nodules in both lungs
Subacute hypersensitivity pneumonitis
Follicular bronchiolitis

* Pathologic Findings (VATS biopsy)
- At low magnification, the small airways were cuffed by an irregular band of lymphocytes and plasma cells (black arrows)
- High power field image(A) shows an interstitial mononuclear inflammatory infiltrate involved the bronchovascular bundle (black arrow) and perivascular bundle (red arrow). The infiltrate consisted of small round lymphocysts and plasma cells.
- At masson’s stain image(B), the centrilobular compartment of the lobule shows fibrosis which was stained purple (black arrows)
Brief Review
Bronchiolocentric interstitial pneumonia is a bronchiolocentric process associated with centrilobular and peribronchiolar fibrosis and a patchy distal lymphocytic alveolitis lacking the presence of interstitial granulomas.

Bronchiolocentric interstitial pneumonia is associated with gas exchange abnormalities.

Patients presented with non-specific symtoms (cough and progressive dyspnea), a restrictive pattern at lung function tests, and peribronchovascular interstitial thickening and traction bronchiectasis on HRCT scans. However, the clinical, imaging and lung function tests were not precisely detailed for most cases in the series.

Most disturbing in bronchiolocentric interstitial pneumonia, in contrast to respiratory bronchiolitis associated with interstitial lung disease and hypersensitivity pneumonitis, is its relatively poor prognosis. At approximately 4 years mean follow-up, 33% of the patients had died of disease and 56% of patients had persistent or progressive complaints.

(Comments from webmaster)

This case is somewhat difficult.
However we would like to introduce the disease entity to the applicants wildly.
Bronchiolocentric fibrosis is a relatively, recently classified disease category and is not familiar to the radiologist.
References
1. Yousem SA, Dacic S. Idiopathic bronchiolocentric interstitial pneumonia.Mod Pathol. 2002 Nov;15(11):1148-53
2. Cordier JF. Challenges in pulmonary fibrosis. 2: Bronchiolocentric fibrosis.Thorax. 2007 Jul;62(7):638-49. Review.
Keywords
Lung, Interstitium, Interstitial lung disease, ILD,

No. of Applicants : 102

▶ Correct Answer : 1/102,  1.0%
  • - Gimpo Woori Hospital , Korea (South) Son Youl Lee
▶ Semi-Correct Answer : 89/102,  87.3%
  • - The Armed Forces HamPyeong Hospital , Korea (South) Bae Geun Oh
  • - Konkuk university hospital , Korea (South) Jeong Geun Yi
  • - ICL , France Ris Labroye
  • - Mackay Memorial Hospital, Taipei, , Taiwan Chia-Fu Tsai
  • - China Medical University,Taiwan,R.O.C. , Taiwan Jun JunYeh
  • - Cheongshim international medical center , Korea (South) yang Hae Jum
  • - Osaka University , Japan Osamu Honda
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - hospital Sao Paulo , Brazil israel missrie
  • - Shinsegye Rad Clinic, Daegu , Korea (South) Gi Beom Kim
  • - Assam medical college, INDIA , India karunakaran M
  • - Aarthi advanced scan centre. , India R.P Babu.
  • - chp st martin , France Mariotte benoit
  • - assam medical college , India PuNeeT JaLaN
  • - Shinchon Severance Hospital , Korea (South) Ho-Joon Lee
  • - Marien Hospital, Hamm , Germany Davis Chiramel
  • - universidad de chile , Chile cristobal gomez
  • - Nantong Rich Hospital , China
  • - mediciti hospitals , India paramjyothi gongati
  • - National Taiwan University Hospital , Taiwan Chin-Chung Shu
  • - St. Mary Hospital , Korea (South) GW JUNG
  • - Trakya Univercity School of Medicine , Turkey Armagan Sarac
  • - CHRU lille , France manuel toledano
  • - Clinic 1 , Russian Federation Lepikhina Darya
  • - Univerisity of Toronto , Canada martin chandonnet
  • - Samsung Medical Center , Korea (South) Dae Kun Oh
  • - Hopital universitaire Lausanne , Switzerland abed kourhani
  • - Asan Medical Center , Korea (South) Eun Jin Chae
  • - Kosin University , Korea (South) Woonha Lee
  • - Asan medical center , Korea (South) Dae Yoon Kim
  • - McGill University Health Center , Canada Alexandre Semionov
  • - MD PG Resident, PIMS,LONI, MAHARASHTRA, INDIA , India Sushant Bhadane
  • - Regional Imaging Ltd. - Riverina, NSW, Australia , Australia Rashid Hashmi
  • - McGill University Health Centre , Canada Amr Ajlan
  • - breach candy hosptial , India rohan kashyape
  • - Chungnam National University hospital , Korea (South) Kyoung Jin Oh
  • - Asian heart institute, Nirman Hitech & Apollo clinic , India Jeshil Shah
  • - E-DA Hospital / I-Shou University , Taiwan Yu-Feng Wei
  • - Louisiana State University - Shreveport , United States Carlos Previgliano
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - kims , India kakarla bhaskar
  • - trakya university , Turkey nermin tuncbilek
  • - Mackay Memorial Hospital , Taiwan Shen ShengYeh
  • - Saga University, Japan , Japan Ryoko Egashira
  • - , Korea (South) Kwon Kim
  • - Lilavati hospital and Research center , India vivek gupta
  • - partner, aditya imaging centre , India vivek patel
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - Dongguk University International Hospital , Korea (South) Hee Seok Choi
  • - All India Institute of Medical Sciences , India puneet kochar
  • - Hanyang university , Korea (South) Ji Young Kim
  • - Institut de Radiologie-Clinique de Genolier , Switzerland arnaud gregoire
  • - KMC,Manipal , India satish maddukuri
  • - Gachon University Gil Medical Center , Korea (South) Soo Jin Choi
  • - University of virginia , United States sucheta sharma
  • - Good Gangan Hospital , Korea (South) Kyung Jung
  • - Soonchunhyang university Bucheon hospital , Korea (South) Minhee Lee
  • - OSWAL CANCER HOSPITAL , India LOVKESH MITTAL
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - SNUH , Korea (South) Mi-Jin Kang
  • - samsung medical center , Korea (South) Tae Yeon Jeon
  • - EKH-Berlin , Germany Michael Weber
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - radiology department ANNECY , France gilles GENIN
  • - IRSA LA ROCHELLE FRANCE , France jean-luc BIGOT
  • - Alnoor Specialist Hospital , Saudi Arabia Ahmed Mohamed
  • - Homs National Hospital , Syria Rami Abou zalaf
  • - Yonsei University college of medicine Severance hospital , Korea (South) Hua Sun Kim
  • - Depatment of Radiology, Yongsan Hospital, College of Medicine, Chung-Ang University , Korea (South) Jae Seung Seo
  • - IRSA La Rochelle France , France Denis Chabassie
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Kashan University of Medical Sciences, kashan, Iran , Iran Ebrahim Razi
  • - Vitalife Clinics , Pune , India. , India Rahul Deshmukh
  • - Pe d , France Fabrice Bing
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - CH de la Ce Basque , France Paul ARDILOUZE
  • - PITTWATER RADIOLOGY , Australia Julie Arora
  • - PITTWATER RADIOLOGY , Australia Saurabh Khandelwal
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - Ruby Hall Clinic , India sudarshan rawat
  • - Soonchunhyang University Cheonan Hospital , Korea (South) Park Sang Hyun
  • - Soon chun hyang university hospital bucheon , Korea (South) Hyelin Kim
  • - Jackson Memorial Hospital , United States Naganathan Mani
  • - Ege University Hospital , Turkey Selen Bayraktaroglu
  • - Armed Forces Chun-Cheon Hospital , Korea (South) ChaeHun Lim
  • - Rohini Scans (P) Ltd. Chennai , India Umapathi Mahesh
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