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Obliterative bronchiolitis, also known as bronchiolitis obliterans or constrictive bronchiolitis, is a type of bronchiolitis and refers to bronchiolar inflammation with submucosal peribronchial fibrosis associated with luminal stenosis and occlusions. Obliterative bronchiolitis should not be confused with cryptogenic organizing pneumonia (COP), previously termed bronchiolitis obliterans organizing pneumonia (BOOP).
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Recognized associations include:
rheumatoid arthritis: considered the commonest connective tissue disease to be associated with obliterative bronchiolitis 11,12
medications, e.g. penicillamine
as a complication following lung transplantation: post lung transplant bronchiolitis obliterans 2; can occur in up to 10% of patients, usually within 6-12 months following bone marrow transplantation 10
Its cardinal features are progressive breathlessness and a dry cough 14.
The condition is characterized by concentric luminal narrowing of the membranous and respiratory bronchioles as a result of submucosal and peribronchiolar inflammation and fibrosis without any intraluminal granulation tissue or polyps/polyposis. There is an absence of diffuse parenchymal inflammation.
It can result from a number of causes:
post-viral (e.g. adenovirus)
post-atypical infection (e.g. Mycoplasma pneumonia)
noxious fume inhalation
"popcorn lung": workers of a microwave popcorn plant who had inhaled diacetyl, a chemical used for flavoring, developed obliterative bronchiolitis; the term has since become a colloquial synonym for obliterative bronchiolitis
neuroendocrine hyperplasia (pulmonary tumourlets) 4
heart/lung transplants 3
representing the obstructive form of chronic lung allograft dysfunction (CLAD)
A helpful mnemonic is CRITTS.
Chest radiographic findings can be normal or, if abnormal, non-specific. Some associated features include:
attenuation of vascular markings
occasionally reticular/reticulonodular markings
On HRCT chest, there are often sharply defined, areas of decreased lung attenuation associated with vessels of reduced caliber. These changes represent a combination of air trapping and oligemia. This combination can give a mosaic attenuation pattern. Other features include:
History and etymology
It was first described by the French physician A C Reynaud in 1835 8,9.
panlobular emphysema: e.g. alpha-1-antitrypsin deficiency
usually has a lower lung zone predominance
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