대한흉부영상의학회 Weekly Chest Cases

Case No : 235 Date 2002-04-27

Courtesy of Min Jeong Kim, M.D., Joon Beom Seo, M.D., Koun-Sik Song, M.D. / Asan Medical Center, Seoul, Korea
Age/Sex 58 / M
Chief ComplaintDyspnea for one year, history of paranasal sinus surgery due to sinusitis

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Diagnosis With Brief Discussion

Diagnosis: Diffuse Panbronchiolitis
Radiologic Findings: Chest radiograph shows increased lung volume and multiple small nodular opacities in both lungs, which are predominant in both lower lobes. Mild bronchial dilatation with bronchial wall thickening is also seen. HRCT scan demonstrates bronchiectasis and bronchiolectasis with air trapping in both lower lobes. Centrilobular nodules and branching linear structures are also seen.
The patient's symptom and radiologic findings improved after medication with erythromycin. The diagnosis of diffuse panbronchiolitis was made based on clinical and radiological findings.
Brief Review: Clinical Manifestation
-middle aged men
-sinusitis (75%)
-superimposed infection: pseudomonas aeruginosa
-die within 5years of the onset (20%)
-Tx: long-term low dose erythromycin
Histology
-centrilobular peribronchiolar infiltrates of acute and chronic inflammatory cells, principally at the level of the respiratory bronchioles
-bronchiolar dilatation and intraluminal inflammatory exudates
Radiologic findings
Chest radiograph
- nonspecific
- small nodular shadows throughout both lungs
- increased lung volumes
Thin-section CT
- centrilobular branching opacities, tree-in-bud appearance
- bronchiolectasis
- bronchiectasis
- diffuse distribution/ basilar predominance
- air-trapping on expiration
- large lung volumes
- mosaic perfusion
References: Akira M, Higashihara T, Sakatani M, et al. Diffuse panbronchiolitis: follow-up CT examination. Radiology 1993;189:559-562
Keywords: Lung, Airway, Non-infectious inflammation,

No. of Applicants : 26

▶ Correct Answer : 20/26, 76.9%

- Bhaktivedanta Hospital, Mumbai, India Sunil S.Jaisingh
- Choong-ju Hospital Konkuk University, Korea Chang Hee Lee
- Dong-A University Hospital, Korea Chan Sung Kim
- Dong-Eui Medical Center, Korea Ha-Jong Lee
- Gospel Hospital Kosin University, Korea Kyung Hwa Jung
- Gwangmoung Seongae Hospital, Korea Jiyong Rhee
- Harasanshin hospital, Fukuoka, Japan Shunya Sunami
- Korea Cancer Center Hospital, Korea Donghee Park
- Ohio State University, Columbus, Ohio, USA Sumit Seth
- Ospedale di Jesi, Italy Giancarlo Passarini
- Planned Parenthood Federation of Korea Kyu Sung Kwack
- Public Health Doctor, Korea Seunghoon Yoo
- Pulmonologist, Korea Jae-Joon Yim
- Samsung Cheil Hospital, Korea Jung Kyu Ryu
- Samsung Medical Center, Korea Young Cheol Yoon
- Samsung Medical Center, Korea Chin A Yi
- Seoul National University Hospital, Korea Chang-Min Park
- Sooncheon Keumdang Hospital, Korea Youngmin Kim
- Sungji Hospital, Korea Jung Hee Kim
- Uiwang Sun Hospital, Korea Ki-Taek Hong

▶ Semi-Correct Answer : 6/26, 23.1%

- Bharat Scans, Chennai, India R G Gopinath
- CHU Nancy-Brabois, France Denis Regent
- Nowon Eulji General Hospital, Korea Sang Hyun Park
- Samsung Medical Center, Korea Hyowon Eun
- Seoul National University Hospital, Korea Seung Hong Choi
- Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 235 Date 2002-04-27

Discussion

No. of Applicants : 26