Bronchiolitis

Zusammenfassung

Der Terminus „Bronchiolitis“ ist ein Sammelbegriff für ein breites Spektrum von Erkrankungen der kleinen Atemwege unterschiedlicher Ätiologie, Histopathologie, Klinik und Prognose. Aufgrund dieser Variabilität sowie der unspezifischen Symptome und Befunde ist eine bronchioläre Erkrankung oft nicht unmittelbar ersichtlich. Anamnese (Rauchgewohnheiten, chronische Erkrankungen wie z. B. Kollagenosen, Inhalation von Irritantien und bestimmten Medikamenten oder vorausgegangene Transplantation), Klinik (Husten, Dyspnoe), körperlicher Befund (systemische oder pulmonale Infektion, Obstruktion, Überblähung), Röntgenthoraxübersicht und Lungenfunktion können zwar auf die Beteiligung der kleinen Atemwege hinweisen, sind jedoch wenig spezifisch und selten diagnostisch. Dagegen bietet das hoch-auflösende CT (HRCT) der Lunge drei distinkte Kriterien mit diagnostischer und differenzialdiagnostischer Bedeutung: (1) das Blütenzweigzeichen (Tree-in-Bud), (2) zentrilobulär lokalisierte Noduli und (3) ein Mosaik-Muster (deutlicher erkennbar im exspiratorischen CT). Die Übersicht fasst die Grundlagen, die Klassifikation, die Bildgebung und die klinische Präsentation der Erkrankungen der kleinen Atemwege zusammen.

Abstract

The term “bronchiolitis” refers to a broad spectrum of common conditions related to the small airways associated with a miscellaneous aetiology, histology, clinical features and course. Due to their variability, bronchiolar disorders are generally difficult to diagnose. History (smoking, collagen vascular disease, inhalational injury, medication usage, and organ transplant) may point towards a bronchiolar process. In addition, signs of systemic and pulmonary infection and evidence of air trapping may provide diagnostic hints. Although clinical presentation, physical examination, pulmonary function tests (obstructive ventilatory defect), and plain chest radiographs may demonstrate abnormalities suggesting small airways involvement, they are often non-specific and rarely diagnostic. In contrast, the high-resolution CT (HR-CT) scanning of the chest provides three distinct HR-CT patterns that assist in the diagnosis and differential diagnosis of bronchiolar conditions: (i) a tree-in-bud pattern, (ii) ill-defined centrilobular ground-glass nodules, and (iii) a mosaic attenuation pattern (best visible on expiratory images). The present paper summarises the current knowledge, the classification, imaging, and the clinical presentation of bronchiolar disorders.

^* für die DESA
DESA (Deutsche Expertengruppe Small Airways) sind Dr. Peter Haidl, Prof. Dr. Martin Kohlhäufl, Dr. Dr. Joachim Körner, Prof. Dr. Dr. Claus Kroegel, Manuela Kulle, Dr. Detlef Nachtigall, Dr. Astrid Riebeling, Prof. Dr. Andreas Schmitt, Prof. Dr. Thomas Voshaar.

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