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Year : 1999  |  Volume : 9  |  Issue : 4  |  Page : 205-206
Obliterative bronchiolitis associated with bronchiectasis


Vardhman Imaging Centre, SDM Hospital Jaipur and Chest and TB Hospital Jaipur, India

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How to cite this article:
Mathur V, Sharma V K. Obliterative bronchiolitis associated with bronchiectasis. Indian J Radiol Imaging 1999;9:205-6

How to cite this URL:
Mathur V, Sharma V K. Obliterative bronchiolitis associated with bronchiectasis. Indian J Radiol Imaging [serial online] 1999 [cited 2020 Jun 2];9:205-6. Available from: http://www.ijri.org/text.asp?1999/9/4/205/28359
Sir,

The presence of obliterative bronchiolitis in patients with bronchiectasis has been increasingly emphasized. Hansell et al [1] suggested that areas of low attenuation on expiratory scans, consistent with obliterative bronchiolitis, are common in patients with chronic purulent sputum production and may be present without overt evidence of bronchiectasis. This suggests that small airway involvement may be an integral part of bronchiectasis and that obliterative bronchiolitis may be an early event in the pathogenesis of the disease. Low attenuation areas in the lung supplied by ectatic bronchi are not clearly discernible, probably due to architectural distortion or associated volume loss. It is believed that bronchiolar obstruction with distal air trapping is the prevalent cause for the development of low attenuation areas [2].

A thirty-six years old man presented with chronic productive cough, occasional hemoptysis and progressively increasing dyspnea. Pulmonary function tests revealed a combined obstructive and restrictive pattern of impairment. A high resolution CT of the lungs showed bronchiectatic changes in the left lung with a mosaic pattern of parenchymal attenuation in the right lung [Figure - 1].

Areas of normal and low attenuation give a mosaic appearance on HRCT sections. There are several causes of a mosaic pattern, including small airways disease, vascular lung disease and infiltrative lung disease [3]. It is important to decide which of the low or high attenuation areas are abnormal. In cases of obliterative bronchiolitis, low attenuation areas have pulmonary vessels fewer in number and smaller in calibre [Figure - 2]. Centrilobular core structures within these areas are smaller in a majority of patients [2]. Evidence of air entrapment is seen in scans obtained at end expiration, which is highly suggestive of small airways disease [1].

 
   References Top

1.Hansell DM, Wells AU, Rubens MB, Cole PJ. Bronchiectasis: Functional significance of decreased attenuation at expiratory CT. Radiology 1994; 193: 369-374.   Back to cited text no. 1  [PUBMED]  
2.Jung Gi IM, Seung Hoon Kin, Myung Jin Chung, Jim Moon Koo and Man Chung Han. Lobular low attenuation of lung parenchyma on CT: Evaluation of forty-eight patients. JCAT 1996; 20: 756-762.   Back to cited text no. 2    
3.Stern EJ, Swensen SJ, Hartman TE, Frank MS. CT mosaic pattern of lung attenuation, distinguishing different causes. AJR 1995; 165: 813-816.  Back to cited text no. 3  [PUBMED]  

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Correspondence Address:
Vidit Mathur
Vardhman Imaging Centre, SDM Hospital Jaipur and Chest and TB Hospital Jaipur
India
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Source of Support: None, Conflict of Interest: None


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[Figure - 1], [Figure - 2]



 

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