Faces of Small Airway Disease

Infection Inflammation Malignancy Mechanical/Atelectasis Trauma Metabolic Circulatory- Hemorrhage Immune Infiltrative Idiopathic Iatrogenic Idiopathic

A’s E I O U

Disease Infection Inflammation

Allergic Bronchopulmonary Aspergillosis (ABPA) Bronchitis and Bronchiectasis 

Bronchiolitis

ABPA Upper Lobe bronchiolitis
CT of the upper lobes show ground glass micronodules reminiscent of small airway disease
Impacted bronchus is noted in the left apex
Ashley Davidoff TheCommonVein.net 135123

Tree in Bud

ABPA and Small Airway Disease Right Lower Lobe 
54 year old female with history of asthma, bronchitis, bronchiectasis, ABPA 
Current CT scan  shows extensive  small airway disease in the right lower lobe, magnified in lower image with centrilobular nodules and thickened interlobular septa characterized by  ground glass micronodules.
Ashley Davidoff TheCommonVein.net

Allergic Bronchopulmonary Aspergillosis (ABPA) Bronchitis and Bronchiectasis 

Tree in Bud Sign Bronchopulmonary Aspergillosis (ABPA)
CT scan through the chest shows medium sized bronchi, bronchioles and small airways impacted with fluid. This collage is presented to reveal tree in bud changes resulting from impaction in the smaller terminal bronchioles and respiratory units. The tree-in-bud pattern also results in small centrilobular nodules connected to multiple branching linear structures of similar caliber from a single stalk. Originally it was felt to result from endobronchial spread of Mycobacterium tuberculosis, but is is now recognized in diverse entities including peripheral airway diseases caused by infection (bacterial, fungal, viral, or parasitic), congenital disorders, idiopathic disorders (obliterative bronchiolitis, pan bronchiolitis), aspiration or inhalation of foreign substances, immunologic disorders, connective tissue disorders and peripheral pulmonary vascular diseases such as neoplastic pulmonary emboli.
In this case there are also dilated medium sized airways, impacted with soft tissue characteristic of the finger in glove sign and most likely due to allergic bronchopulmonary aspergillosis (ABPA)
Ashley Davidoff MD Ashley Davidoff MD TheCommonVein.net
47113c01

Aspiration

CT Axial Projection Acute Aspiration
73-year-old man presents with respiratory difficulty following trauma and difficult placement of a nasogastric tube. CT scan through the chest at the level of the left atrium shows aspirated material in the left lower segmental airways and inferior lingula airways. There is thickening of the right sided segmental airways as well. Extensive ill-defined micronodules are noted throughout the lung fields. Centrilobular nodules are noted in the periphery of the left lower lobe. In the clinical context of technical difficulty with a recently placed NG tube acute, aspiration of fluid gastric content with small airway involvement is a diagnostic consideration despite the lack of alveolar changes
Ashley Davidoff MD TheCommonVein.net 135763c
CT in the coronal projection from a patient with UIP (upper image) shows predominantly basilar  reticular disease with some extension to the upper lobes.  In the middle magnified images there is thickening of the wall of a few of the visualized bronchioles The lower magnified images show solid centrilobular nodules. No air trapping was identified
Ashley Davidoff MD TheCommonVein.net uip-002c-CT

 

  • Bronchiolar Inflammation
    •  AEIOU
      • A
        • Asthma ABPA Asbestosis
      • E
        • Eosinophilic Pneumonia
      • Infections
        • Endobronchial
          • TB
            • Mycobacterium
            • Non TB Mycobacteria and
            • Other Granulomatous Infections
          • ABPA
        • viruses such as
          • adenovirus,
          • influenza, and
          • respiratory syncytial virus (RSV),
      • Inflammatory
          • Sarcoidosis
          • Inhalational
            • Cigarette Smoke
              • smokers bronchiolitis
              • Langerhans Cell
            • chemicals,
            • fumes, or toxic gases
            • occupational exposures,
              • industrial chemicals
                • diacetyl in the popcorn industry
      • Immune
            • HP
            • RA
            • Follicular Bronchiolitis (MALT Lymphoid Hyperplasia  in collagen vasc and immune deficiency)
            • Graft vs Host
      • Inherited
        • Cystic Fibrosis
      • Idiopathic Bronchiolitis Obliterans