대한흉부영상의학회 Weekly Chest Cases

Case No : 380 Date 2005-02-05

Courtesy of So Yeon Kim, M.D., Jae Woo Somg, M.D. / Asan Medical Center, Ulsan University, Seoul, Korea
Age/Sex 48 / F
Chief ComplaintCough and yellowish sputum for seven months

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Diagnosis With Brief Discussion

Diagnosis: Diffuse Panbronchiolitis associated infection
Radiologic Findings: ??Chest radiograph at admission shows diffuse small ill-defined nodular opacities most prominent over the lung bases and symmetrically distributed. Mild to moderate hyperinflation is also noted. HRCT scans demonstrate bronchiolectasis with thickening of bronchiolar wall and centrilobular nodules. Follow-up chest radiograph after antiobiotics shows marked decrease of the nodular infiltration, but persisted peribronchial infiltration. Haemophilus influenzae is isolated in the sputum of the patient. PNS examination revealed pansinusitis
Brief Review: Diffuse panbronchiolitis (DPB) is an idiopathic inflammatory disease that is not uncommon in Japan, Korea, and China. It is characterized by progressive suppurative and obstructive airway disease, first involving the sinuses and respiratory bronchioles, which, left untreated, progresses to bronchiectasis, respiratory failure, and death. Its distinctive imaging and histologic features, the presence of sinusitis, and the isolation of Haemophilus influenzae and Pseudomonas aeruginosa in the sputum should enhance disease recognition. In the early stages of the disease, the sputum generally contains normal flora or Hemophilus influenzae. Colonization with Pseudomonas aeruginosa eventually occurs, which appears to accelerate the destructive process. The natural history of diffuse panbronchiolitis is characterized by progressive respiratory dysfunction with episodic bacterial superinfection, often with P. aeruginosa. If DPB is left untreated, only 12 to 25% of patients survive 10 years. The long-term use of low-dose erythromycin therapy has proven to be highly effective in treating patients with DPB.
References: 1. Kenneth W T Tsang, Clara G C Ooi, Mary S M Ip, et al. Clinical profiles of Chinese patients with diffuse panbronchiolitis Chest. 2002;121:659-661.

2. Fitzerald JE, King TE Jr, Lynch DA, Tuder RM, Schwarz MI. Diffuse panbronchiolitis in the United States. Am J Respir Crit Care Med 1996;154:497?503.
Keywords: Airway, Infection, Bacterial infection,

No. of Applicants : 41

▶ Correct Answer : 22/41, 53.7%

- Annecy Hospital, France Gilles Genin
- Annemasse, Polyclinique de Savoie, France Gay-Depassier Philippe
- Apollo Hospitals, Colombo P.Xavier Rajesh
- ASL BOLOGNA Maggiore Hospital, Bologna, Italy Marcellino Burzi
- Centre d'imagerie Jacques Callot, Nancy, France Lionel Cannard
- Chonbuk National University Hospital, Korea Gong Yong Jin
- CIM Saint Dizier, France JC Leclerc
- Dong-A University Hospital, Korea Ki-Nam Lee
- Hanyang University Hospital, Seoul, Korea Yo Won Choi
- Homs National Hospital, Homs, Syria Rami Abou Zalaf
- Incheon Sarang Hospital, Korea Jung Hee Kim
- Jikei University of medicine, Japan Shigeki Misumi
- Max Hospital, Delhi, India Vickrant Malhotra
- Medical Specialists, Munster, USA Fadi Layous
- National Taiwan University Hospital, Taiwan Shen-Hsiang Lin
- Ping Tung Christian Hospital,Taiwan Jun-Jun Yeh
- Seoul National University Hospital, Korea Seung Hong Choi
- Seoul National University Hospital, Korea Dae Sik Kim
- Seoul National University Hospital, Korea Chang Hyun Lee
- Seoul National University Hospital, Korea Heesun Park
- Social Security Hospital, Ankara, Turkey Meric Tuzun
- Yonsei University College of Medicine, Korea Jung-hwan Lee

▶ Semi-Correct Answer : 4/41, 9.8%

- Apollo Firstmed Hospitals, Chennai,India RG Gopinath
- Asan Medical Center, Korea Eun Jin Chae
- Busan Veterans Hospital, Korea Suhku Huh
- CHU Nancy-Brabois, France Denis Regent

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 380 Date 2005-02-05

Discussion

No. of Applicants : 41