|





` characterized by occurrence in patients who
smoke and, more rarely, in those with collagen
vascular diseases and mineral dustʹinduced
diseases
` Histology: submucosal inflammation and fibrosis
of the respiratory bronchioles consisting of
fibrotic mural thickening and mononuclear cell
infiltration; Pigmented macrophages are present
in the bronchiolar lumen
 |




` High-resolution CT: ill-defined centrilobular
nodules; Small patches of ground-glass
opacity; may predominate in the upper lobes
Fig. 2Ͷ^ -year-old cigarette smoker with respiratory
bronchiolitis. High-resolution CT image shows diffuse fine
poorly defined centrilobular nodules (
£ with more
patchy ground-glass opacity posteriorly.
 |






   
 



` 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
Fig. 10Ͷ[ -year-old
female cigarette
smoker with
respiratory
bronchiolitisʹ
associated interstitial
lung disease. High
resolution CT image
through right mid
lung shows patchy
groundglass opacity
with centrilobular
nodules (£.
Ñ
ging Differenti
 Di
gnosis
ÿesquamative Interstitial Pneumonia
Nonspecific Interstitial Pneumonia
Hypersensitivity pneumonitis
Less common centrilobular nodules;
ground-glass opacity of respiratory
bronchiolitisʹassociated interstitial
lung disease is patchier and poorly
defined
ground-glass opacity is usually more
diffuse and is commonly associated with a
reticular abnormality
centrilobular nodules and ground-glass
opacity are usually more diffuse; most
patients are nonsmokers
 F



` characterized by lymphoid hyperplasia of
bronchus-associated lymphoid tissue (BALT£
` Histology: presence of hyperplastic lymphoid
follicles with reactive germinal centers
distributed along the bronchioles and, to a
lesser extent, the bronchi
` Lymphocytes are polyclonal on
immunohistochemistry
 F



`  ost cases of follicular bronchiolitis are
associated with collagen vascular diseases,
particularly rheumatoid arthritis and Sjögren͛s
syndrome
` High-resolution CT: centrilobular and
peribronchial nodules, most being around 3 mm
in size, but ranging from 1 to 12 mm; tree-in-bud
pattern may be present; Areas of ground-glass
opacity and rarely bronchial dilatation and
interlobular septal thickening may also be seen
Fig. 12Ͷ3 -year-old
woman with
rheumatoid arthritis
and follicular
bronchiolitis. High-
resolution CT image
shows tree-in-bud
pattern (
£
with a few larger
nodules and occasional
discrete small thin-
walled cysts (£.
 



` unique entity of unknown cause that is seen
mainly in Asia, especially Japan and Korea
` typically affects middle-aged men and has no
relationship to smoking
` associated with the human leukocyte antigenʹ
genotype Bw^[ in more than 6
of the cases
` Progressive cough, dyspnea, and severe
pansinusitis are seen
 



` Treatment: Long-term lowdose erythromycin is
recommended
` Histology: transmural inflammatory nodules are
composed of mononuclear cells centered on the
respiratory bronchioles; Foamy macrophages are
present in the interstitium around the
bronchioles and within the alveoli
` High-resolution CT: centrilobular opacities with
branching lines (tree-in-bud pattern£,
bronchiolectasis, and bronchiectasis; basal and
peripheral lung predominance
` Fig. 3Ͷ^ -year-old
American woman of
Asian origin with
panbronchiolitis.
High-resolution CT
image of chest shows
centrilobular nodules
with tree-in-bud
pattern (

£,
bronchiolectasis
(£, and cylindric
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.