Bronchiolitis

Question 1

What are bronchioles

Answer 1

Small airways
Bronchial epithelium
No cartilage

Question 2

Features of proliferative bronchiolar disease

Answer 2

Non specific reaction to bronchiolar injury causing exudate in lumen
Intralumenal fibrotic buds called Mason bodies
Alveolar wall inflammation
Foamy macrophages

Question 3

What are the two main pathological patterns of bronchiolar disease + which is more common

Answer 3

Proliferative - more common
Constrictive

Question 4

Features of constrictive bronchiolar disease

Answer 4

Concentric narrowing due to cellular infiltrates and smooth muscle hyperplasia
Patchy
Typically progresses and doesn’t respond to steroids

Question 5

Rare causes of proliferative bronchiolitis

Answer 5

ARDS
Vasculitis
Drug induced - coke, busulfan
Chronic thyroiditis
Radiation/aspiration
UC
Distal bronchial obstruction
CVID

Question 6

Common causes of proliferative bronchiolitis

Answer 6

Cryptogenic organizing pneumonia
Hypersensitivity pneumonitis
Chronic eosinophilic pneumonia
CTD
Post transplant - bone marrow, heart, lung
Organising acute infection

Question 7

Common causes of constrictive bronchiolitis

Answer 7

CTD - RA
Infection - RSV, adenovirus,

Question 8

Rare causes of constrictive bronchiolitis

Answer 8

Chronic transplant rejection - occurs in 65% of transplants at 5 years
Diffuse pan bronchiolitis
Inhalation injury
Drug reaction
Hypersensitivity reaction
UC
Cryptogenic

Question 9

Clinical presentation bronchiolitis

Answer 9

Insidious onset
Cough and SOB weeks to months
Ax trigger in hx

Question 10

PFTs picture in constrictive bronchiolitis

Answer 10

Obstructive
Air trapping
No reversibility
Impaired TLCO

Question 11

PFTs picture in proliferative bronchiolitis

Answer 11

restrictive or mixed defect
Impaired TLCO

Question 12

CXR findings in bronchiolitis

Answer 12

Diffuse infiltrates with proliferative changes

Question 13

HRCT findings in bronchiolitis

Answer 13

Hyperinflation
Air trapping
Mosaic attentuation
Subsegmental atelectasis

Question 14

Who gets Diffuse Pan Bronchiolitis

Answer 14

Japan
Middle aged men
Non smoking

Question 15

Diffuse Pan Bronchiolitis presentation

Answer 15

Sinusitis
Productive cough, copious sputum
Can progress to resp failure

Obstructive PFTs

Question 16

Tx Diffuse Pan Bronchiolitis

Answer 16

Erythromycin

Question 17

BAL Diffuse Pan Bronchiolitis

Answer 17

Neutrophilia
Cold agglutins +ve

Question 18

Tx acute bronchiolitis infants

Answer 18

Supportive

Question 19

What is bronchiolitis obliterans

Answer 19

Chronic inflammation and irreversible scarring of bronchioles

Obstructive!

Question 20

Causes bronchiolitis obliterans

Answer 20

Lung/stem cell transplant

Toxin inhalation

Auto immune - SLE/RA/IBD

Post viral, esp in children

HIV, HHV, Castlemans

Question 21

Rx obliterative bronchiolitis

Answer 21

If transplant, optimise immunosuppression (as in this context it’s a form of graft vs host)

Azithro

Tx GORD