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Case No : 1

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  • Age/Sex 25 / M
  • Case Title 25-year-old man with chronic cough for 1 month
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Diagnosis With Brief Discussion

Courtesy
E
Imaging Findings
Chest radiograph shows poorly-defined small nodules in both lungs, predominantly in lower lung zones.
Water's view shows haziness and mucoperiosteal thickening in both maxillary sinuses.
Chest high-resolution CT scans reveal poorly-defined centrilobular nodules and linear branching structures
in association with bronchiolectasis in both lungs, predominantly in lower lung zones.
Discussion
Diffuse panbronchiolitis is a disease of unknown etiology and pathogenesis characterized by
chronic inflammation of respiratory bronchioles with secondary obstructive effects.
Most patients are more than 40 years old; the male to female ratio is approximately 2 to 1.
The chief clinical manifestations are chronic cough, sputum production, dyspnea on exertion, wheezing and hypoxemia.
Recurrent pulmonary infection is characteristic and chronic sinusitis is frequently associated.
In the late stages, sputum culture often reveals the presence of microorganisms, especially Pseudomonas aeruginosa,
suggesting the development of airway colonization.

The typical pathologic features of DPB lesions are thickening of the walls of the respiratory bronchioles
with infiltration of lymphocytes, plasma cells, and histiocytes and extension of these inflammatory changes toward the peribronchiolar tissues.
In the advanced stage, narrowing and constriction of respiratory bronchioles by infiltration of these cells,
proliferation of lymph follicles, and accumulation of foamy cells within the wall and neighboring area,
and secondary ectasis of proximal terminal bronchioles occur.

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.

On HRCT, DPB is identified as changes consisting of
(a) centrilobularly distributed, small rounded areas of high attenuation;
(b) branched linear areas of high attenuation contiguous to the small rounded areas;
(c) dilated airways with thick walls; and
(d) decreased lung attenuation in the peripheral areas.

The prognosis of DPB is grave, and many patients die of respiratory failure.
Long-term administration of low dose erythromycin is effective, although the treatment become ineffective as DPB progressed.
Reference
1. Akira M, Kitatani F, Lee YS. Diffuse panbronchiolitis: evaluation with high-resolution CT. Radiology 1988; 168:433-438
2. Nishimura K, Kitaichi M, Izumi T et al. Diffuse panbronchiolitis: correlation of high-resolution CT and pathologic findings. Radiology 1992; 184:779-785
3. Akira M, Higashihara T, Sakatani M et al. Diffuse panbronchiolitis: follow-up CT examination. Radiology 1993; 189:559-562
Keywords
AirwayAirway, Non-infectious inflammation,
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