Disorders of the Small Airways: High-Resolution Computed Tomographic Features

Tomás Franquet; Nestor L. Müller

doi:10.1055/s-2003-42378

Seminars in Respiratory and Critical Care Medicine, Table of Contents

Semin Respir Crit Care Med 2003; 24(4): 437-444
DOI: 10.1055/s-2003-42378

Disorders of the Small Airways: High-Resolution Computed Tomographic Features

Tomás Franquet^1,2 , Nestor L. Müller¹

¹Department of Radiology, Vancouver Hospital and Health Sciences Centre and University of British Columbia, Vancouver, British Columbia, Canada
²Department of Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain

Abstract

ABSTRACT

Several infectious and noninfectious processes may affect predominantly or exclusively the small airways and result in reversible or irreversible abnormalities. Small-airway diseases can be considered as synonymous with bronchiolitis and can be classified into three main categories: (a) obliterative (constrictive) bronchiolitis, (b) cellular bronchiolitis, and (c) respiratory bronchiolitis. The introduction of high-resolution computed tomography (HRCT) has led to a considerable improvement in our ability to diagnose small-airway diseases. The characteristic HRCT findings of obliterative bronchiolitis consist of areas of decreased attenuation and vascularity with blood flow redistribution resulting in areas of increased lung attenuation and vascularity ("mosaic perfusion" pattern). In cellular bronchiolitis, the characteristic HRCT findings consist of centrilobular nodules and branching opacities ("tree-in-bud" pattern). Finally, bilateral areas of ground-glass attenuation and/or poorly defined centrilobular nodules are characteristic of respiratory bronchiolitis and respiratory bronchiolitis-associated interstitial lung disease (RB-ILD). This article reviews the clinical, pathological, and HRCT features of some of the most common small-airway diseases

KEYWORDS

High-resolution CT - bronchiolitis - small-airway diseases

Full Text

References

REFERENCES

1 Müller N L, Miller R R. Diseases of the bronchioles: CT and histopathologic findings. Radiology . 1995; 196 3-12
2 Hansell D M. HRCT of obliterative bronchiolitis and other small-airways diseases. Semin Roentgenol . 2001; 36 51-65
3 Itoh H, Murata K, Konishi J, Nishimura K, Kitaichi M, Izumi T. Diffuse lung disease: pathologic basis for the high-resolution computed tomography findings. J Thorac Imaging . 1993; 8 176-188
4 Murata K, Itoh H, Todo G. et al . Centrilobular lesions of the lung: demonstration by high-resoltution CT and pathologic correlation. Radiology . 1986; 161 641-645
5 Stern E J, Frank M S. Small-airway diseases of the lungs: findings at expiratory CT. AJR Am J Roentgenol . 1994; 163 37-41
6 Webb W R, Stern E J, Kanth N, Gamsu G. Dynamic pulmonary CT findings in healthy adult men. Radiology . 1993; 186 117-124
7 Stern E J, Müller N L, Swensen S J, Hartman T E. CT mosaic pattern of lung attenuation: etiologies and terminology. J Thorac Imaging . 1995; 10 294-297
8 Stern E J, Swensen S J, Hartman T E, Frank M S. CT mosaic pattern of lung attenuation: distinguishing different causes. AJR Am J Roentgenol . 1995; 165 813-816
9 Worthy S A, Müller N L, Hartman T E, Swensen S J, Padley S PG, Hansell D M. Mosaic attenuation pattern on thin section CT scans of the lung: differentiation among infiltrative lung, airway, and vascular diseases as a cause. Radiology . 1997; 205 465-470
10 Franquet T, Stern E J, Giménez A, Sabaté J M, Domingo P. Lateral decubitus CT: a useful adjunct to standard inspiratory-expiratory CT for the detection of air-trapping. AJR Am J Roentgenol . 2000; 174 528-530
11 Lucidarme O, Grenier P A, Cadi M, Mourey-Gerosa I, Benali K, Cluzel P. Evaluation of air trapping at CT: comparison of continuous-versus suspended expiration CT techniques. Radiology . 2000; 216 768-772
12 Hansell D M, Wells A U, Rubens M B. et al . Bronchiectasis: functional significance of areas of decreased attenuation at expiratory CT. Radiology . 1994; 193 369-374
13 Lucidarne O, Grenier P, Coche E, Lenoir S, Aubert B, Beigelman C. Bronchiectasis: comparative assessment with thin-section CT and helical CT. Radiology . 1996; 200 673-679
14 Napel S, Rubin G D, Jeffrey R B. STS-MIP: a new reconstruction technique for CT of the chest (technical note). J Comput Assist Tomogr . 1993; 17 832-838
15 Bhalla M, Naidich D P, McGuinness, Gruden J F, Leitman B S, McCauley D I. Diffuse lung disease: assessment with helical CT-preliminary observations of the role of maximum and minimum intensity projection images. Radiology;. 1996; 200 341-347
16 Remy-Jardin M, Remy J, Gosselin B, Copin M C, Wurtz A, Duhamel A. Sliding thin slab, minimum intensity projection technique in the diagnosis of emphysema: histopathologic-CT correlation. Radiology . 1996; 200 665-671
17 Hartman T E, Primack S L, Lee K S, Swensen S J, Müller N L. CT of bronchial and bronchiolar diseases. RadioGraphics . 1994; 14 991-1003
18 Teel G S, Engeler C E, Tashijian J H, duCret R P. Imaging of small airways disease. RadioGraphics . 1996; 16 27-41
19 Gruden J F, Webb W R, Warnock M. Centrilobular opacities in the lung on high-resolution CT: diagnostic considerations and pathologic correlation. AJR Am J Roentgenol . 1994; 162 569-574
20 Worthy S A, Flower C DR. Computed tomography of the airways. Eur Radiol . 1996; 6 717-729
21 Hwang J H, Kim T S, Lee K S. et al . Bronchiolitis in adults: pathology and imaging. J Comput Assist Tomogr . 1996; 21 913-919
22 Arakawa H, Webb W R, McCowin M, Katsou G, Lee K N, Seitz R F. Inhomogeneous lung attenuation at thin-section CT: Diagnostic value of expiratory CT scans. Radiology . 1998; 206 89-94
23 Myers J L, Colby T V. Pathologic manifestations of bronchiolitis, constrictive bronchiolitis, cryptogenic organizing pneumonia, and diffuse panbronchiolitis. Clin Chest Med . 1993; 14 611-622
24 Kothari N A, Kramer S S. Bronchial diseases and lung aireation in children. J Thorac Imag . 2001; 16 207-223
25 Lucaya J, Gartner S, Garcia-Peña P. et al . Spectrum of manifestations of Swyer-James-McLeod syndrome. J Comput Assist Tomogr . 1998; 22 592-597
26 Cooper J D, Billingham M, Egan T. et al . A working formulation for the standardization of nomenclature and for clinical staging of chronic dysfunction in lung allografts: International Society for Heart and Lung Transplantation. J Heart Lung Transplant . 1993; 12 713-716
27 Lee E S, Gotway M B, Reddy G P, Golden J A, Keith F M, Webb W R. Early bronchiolitis obliterans following lung transplantation: accuracy of expiratory thin-section CT for diagnosis. Radiology . 2000; 216 472-477
28 Leung A N, Fisher K, Valentine V. et al . Bronchiolitis obliterans after lung transplantation: detection using expiratory HRCT. Chest . 1998; 113 365-370
29 Aquino S L, Webb W R, Golden J. Bronchiolitis obliterans associated with rheumatoid arthritis: findings on HRCT and dynamic expiratory CT. J Comput Assist Tomogr . 1994; 18 555-558
30 Wells A U, du Bois M R. Bronchiolitis in association with connective tissue disorders. Clin Chest Med . 1993; 14 655-666
31 Camus P, Piard F, Ashcroft T, Gal A A, Colby T V. The lung in inflammatory bowel disease. Medicine . 1993; 72 151-183
32 Mahadeva A, Walsh G, Flower C DR, Shneerson J M. Clinical and radiological characteristics of lung disease in inflammatory bowel disease. Eur Respir J . 2000; 15 41-48
33 McCloud T C, Epler G R, Colby T V, Gaensler E A, Carrington C B. Bronchiolitis obliterans. Radiology . 1986; 159 1-8
34 Stern E J, Webb W R, Gamsu G. Dynamic quantitative computed tomography: a predictor of pulmonary function in obstructive lung diseases. Invest Radiol . 1994; 29 564-569
35 Im J G, Itoh H, Shim Y S. et al . Pulmonary tuberculosis: CT findings: early active disease and sequential change with antituberculous therapy. Radiology . 1993; 186 653-660
36 Aquino S L, Gamsu G, Webb W R, Kee S T. Tree-in-bud pattern: frequency and significance on thin section CT. J Comput Assist Tomogr . 1996; 20 594-599
37 Niewoehner D E, Kleinerman J, Rice D B. Pathologic changes in the peripheral airways of young cigarette smokers. N Engl J Med . 1974; 291 755-758
38 Myers J L, Veal Jr F C, Shin M S, Katzenstein A LA. Respiratory bronchiolitis causing interstitial lung disease: a clinicopathologic study of six cases. Am Rev Respir Dis . 1987; 135 880-884
39 Heyneman L E, Ward S, Lynch D A, Remy-Jardin M, Johkoh T, Müller N L. Respiratory bronchiolitis, respiratory bronchiolitis-associated interstitial lung disease, and desquamative interstitial pneumonia: different entities or part of the spectrum of the same disease process?. AJR Am J Roentgenol . 1999; 173 1617-1622
40 Fraig M, Shreesha U, Savici D, Katzenstein A LA. Respiratory bronchiolitis: a clinicopathologic study in current smokers, ex-smokers, and never smokers. Am J Surg Pathol . 2002; 26 647-653
41 Remy-Jardin M, Remy J, Gosselin B, Becette V, Edme J L. Lung parenchymal changes secondary to cigarette smoking: pathologic-CT correlations. Radiology . 1993; 186 643-651
42 Park J S, Brown K K, Tuder R M, Hale V A, King Jr E T, Lynch D A. Respiratory bronchiolitis-associated interstitial lung disease: radiologic features with clinical and pathologic correlation. J Comput Assist Tomogr . 2002; 26 13-20