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8/7/2019 journal ppt
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8/7/2019 journal ppt
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8/7/2019 journal ppt
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Respiratory Bronchiolitis
High-resolution CT: ill-defined centrilobular
nodules; Small patches of ground-glass
opacity; may predominate in the upper lobes
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Fig. 257-year-old cigarette smoker with respiratorybronchiolitis. High-resolution CT image shows diffuse finepoorly defined centrilobular nodules (arrows) with morepatchy ground-glass opacity posteriorly.
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Respiratory
BronchiolitisAssociated Interstitial Lung
Disease Severe symptoms than respiratory
bronchiolitis and causes impairment of lung
function and gas exchange
patchy areas of ground-glass opacity and air
trapping are usually present
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Fig. 1040-year-oldfemale cigarettesmoker withrespiratorybronchiolitisassociated interstitial
lung disease. Highresolution CT image
through right midlung shows patchy
groundglass opacitywith centrilobular
nodules (arrow).
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Imaging Differential DiagnosisD
esquamative Interstitial Pneumonia Less common centrilobular nodules;ground-glass opacity of respiratory
bronchiolitisassociated interstitial
lung disease is patchier and poorly
defined
Nonspecific Interstitial Pneumonia ground-glass opacity is usually morediffuse and is commonly associated with a
reticular abnormality
Hypersensitivity pneumonitis centrilobular nodules and ground-glassopacity are usually more diffuse; most
patients are nonsmokers
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Follicular Bronchiolitis
characterized by lymphoid hyperplasia of
bronchus-associated lymphoid tissue (BALT)
Histology: presence of hyperplastic lymphoidfollicles with reactive germinal centers
distributed along the bronchioles and, to a
lesser extent, the bronchi
Lymphocytes are polyclonal on
immunohistochemistry
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Follicular Bronchiolitis
Most cases of follicular bronchiolitis areassociated with collagen vascular diseases,particularly rheumatoid arthritis and Sjgrens
syndrome High-resolution CT: centrilobular and
peribronchial nodules, most being around 3 mmin size, but ranging from 1 to 12 mm; tree-in-bud
pattern may be present; Areas of ground-glassopacity and rarely bronchial dilatation andinterlobular septal thickening may also be seen
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Fig. 1237-year-old
woman with
rheumatoid arthritis
and follicular
bronchiolitis. High-
resolution CT imageshows tree-in-bud
pattern (arrowhead)
with a few larger
nodules and occasionaldiscrete small thin-
walled cysts (arrow).
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Diffuse Panbronchiolitis
unique entity of unknown cause that is seen
mainly in Asia, especially Japan and Korea
typically affects middle-aged men and has norelationship to smoking
associated with the human leukocyte antigen
genotype Bw54 in more than 60% of the cases
Progressive cough, dyspnea, and severe
pansinusitis are seen
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Diffuse Panbronchiolitis
Treatment: Long-term lowdose erythromycin isrecommended
Histology: transmural inflammatory nodules are
composed of mononuclear cells centered on therespiratory bronchioles; Foamy macrophages arepresent in the interstitium around thebronchioles and within the alveoli
High-resolution CT: centrilobular opacities withbranching lines (tree-in-bud pattern),bronchiolectasis, and bronchiectasis; basal andperipheral lung predominance
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Fig. 350-year-old
American woman of
Asian origin withpanbronchiolitis.
High-resolution CT
image of chest shows
centrilobular nodules
with tree-in-bud
pattern (arrowheads),
bronchiolectasis(arrow), and cylindric
bronchiectasis.
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Bronchiectasis
Signs of inflammatory and fibrotic
bronchiolitis are frequently seen in patients
with bronchiectasis of any cause, including
cystic fibrosis, immune deficiency, and
previous infection, presumably because the
pathologic process involving the bronchi has
also involved the small airways.