Abstract
PURPOSE: To evaluate the thin-section computed tomographic (CT) findings of follicular bronchiolitis and compare them with the histologic findings.
MATERIALS AND METHODS: Thin-section CT scans obtained in 12 patients (age range, 24–77 years; mean age, 47 years) with follicular bronchiolitis proved at open lung biopsy were reviewed by two observers. Underlying conditions included rheumatoid arthritis (n = 8), mixed collagen vascular disorders (n = 2), autoimmune disorder (n = 1), and acquired immunodeficiency syndrome (n = 1). All patients had thin-section CT scans (1.0–1.5-mm collimation, 11 patients; 3.0-mm collimation, one patient; high-spatial-frequency reconstruction algorithm) obtained at 10-mm intervals through the chest.
RESULTS: The main CT findings included bilateral centrilobular (n = 12) and peribronchial (n = 5) nodules. All 12 patients had nodules smaller than 3 mm in diameter; six patients also had nodules 3–12 mm in diameter. Areas of ground-glass opacity were present in nine (75%) patients. Histologically, all patients had lymphoid hyperplasia along the bronchioles; eight had peribronchiolar lymphocytic infiltration.
CONCLUSION: The cardinal CT feature of follicular bronchiolitis consists of small centrilobular nodules variably associated with peribronchial nodules and areas of ground-glass opacity.
References
- 1 Myers JL, Kurtin PJ. Lymphoid proliferative disorders of the lung. In: Thurlbeck WM, Churg AM, eds. Pathology of the lung. 2nd ed. New York, NY: Thieme, 1995; 535-588.
- 2 Yousem SA, Colby TV, Carrington CB. Follicular bronchitis/bronchiolitis. Hum Pathol 1985; 16:700-706.
- 3 Fortoul TI, Cano-Valle F, Oliva E, Barrios R. Follicular bronchiolitis in association with connective tissue diseases. Lung 1985; 163:305-314.
- 4 Hayakawa H, Sato A, Imokawa S, Toyoshima M, Chida K, Iwata M. Bronchiolar disease in rheumatoid arthritis. Am J Respir Crit Care Med 1996; 154:1531-1536.
- 5 Kinoshita M, Higashi T, Tanaka C, Tokunaga N, Ichikawa Y, Oizumi K. Follicular bronchiolitis associated with rheumatoid arthritis. Intern Med 1992; 31:674-677.
- 6 Remy-Jardin M, Remy J, Cortet B, Mauri F, Declambre B. Lung changes in rheumatoid arthritis: CT findings. Radiology 1994; 193:375-382.
- 7 Remy-Jardin M, Remy J, Wallaert B, Bataille D, Hatron P. Pulmonary involvement in progressive systemic sclerosis: sequential evaluation with CT, pulmonary function tests, and bronchoalveolar lavage. Radiology 1993; 188:499-506.
- 8 Bienenstock J, Johnston N, Perey DYE. Bronchial lymphoid tissue. I. Morphologic characteristics. Lab Invest 1973; 28:686-692.
- 9 Reittner P, Fotter R, Lindbichler F, et al. HRCT features in a 5-year-old child with follicular bronchiolitis. Pediatr Radiol 1997; 27:877-879.
- 10 Lentz D, Bergin CJ, Berry GJ, Stoehr C, Theodore J. Diagnosis of bronchiolitis obliterans in heart-lung transplantation patients: importance of bronchial dilatation on CT. AJR 1992; 159:463-467.
- 11 Müller NL, Miller RR. Diseases of the bronchioles: CT and histopathologic findings. Radiology 1995; 196:3-12.
- 12 Amorosa JK, Miller RW, Laraya-Cuasay L, et al. Bronchiectasis in children with lymphocytic interstitial pneumonia and acquired immune deficiency syndrome: plain film and CT observations. Pediatr Radiol 1992; 22:603-607.
- 13 Kradin RL, Mark EJ. Benign lymphoid disorders of the lung, with a theory regarding their development. Hum Pathol 1983; 14:857-867.
- 14 Nicholson AG, Wotherspoon AC, Diss TC, et al. Reactive pulmonary lymphoid disorders. Histopathology 1995; 26:405-412.
- 15 Strimlan CV, Rosenow EC, Divertie MB, et al. Pulmonary manifestations of Sjogren's syndrome. Chest 1976; 70:354-361.
- 16 White DN, Mattay RA. Non-infectious pulmonary complications of infection with the human immunodeficiency virus. Am Rev Respir Dis 1989; 140:1763-1787.
- 17 Fraser RG, Pare JAP, Pare PD, Fraser RS, Genereux GP. Diagnosis of diseases of the chest 3rd ed. Philadelphia, Pa: Saunders, 1988; 1568-1573.
- 18 Ishikawa Y, Kinoshita M, Koga T, Oizumi K, Fujimoto K, Hayabuchi N. Lung cyst formation in lymphocytic interstitial pneumonia: CT features. J Comput Assist Tomogr 1994; 18:745-748.
- 19 Berdon WE, Mellins RB, Abramson SJ, Ruzal-Shapiro C. Pediatric HIV infection in its second decade: the changing pattern of lung involvement—clinical, plain film, and computed tomographic findings. Radiol Clin North Am 1993; 31:453-464.
- 20 McGuinness G, Scholes JV, Jagirdar JS, et al. Unusual lymphoproliferative disorders in nine patients with HIV or AIDS: CT and pathologic findings. Radiology 1995; 197:59-65.
- 21 Desai SR, Nicholson AG, Stewart S, Twentyman OM, Flower DR, Hansell DM. Benign pulmonary lymphocytic infiltration and amyloidosis: computed tomographic and pathologic features in three cases. J Thorac Imaging 1997; 12:215-220.
- 22 Gruden JF, Webb WR, Warnock M. Centrilobular opacities in the lung on high-resolution CT: diagnostic considerations and pathologic correlation. AJR 1994; 162:569-574.
- 23 Murata K, Itoh H, Todo G, et al. Centrilobular lesions of the lung: demonstration by high-resolution CT and pathologic correlation. Radiology 1986; 161:641-645.
- 24 Murata K, Khan A, Herman PG. Pulmonary parenchymal disease: evaluation with high-resolution CT. Radiology 1989; 172:467-471.
- 25 Gurney JW. Cross-section physiology of the lung. Radiology 1991; 178:1-10.
- 26 Epler GR, Snider GL, Gaensler EA, Cathcart ES, Fitzgerald MX, Carrington CB. Bronchiolitis and bronchitis in connective tissue disease: a possible relationship to the use of penicillamine. JAMA 1979; 242:528-532.
- 27 Wells AU, du Bois RM. Bronchiolitis in association with connective tissue disorders. Clin Chest Med 1993; 14:655-666.