Buzz words
Respiratory bronchiolitis
All smokers
Usually symptomatic and no clinical significance
Respiratory bronchiolitis ILD
Etiology Cigarette Smoke
Difference between RB , RB ILD and desquamative interstitial pneumonia (DIP) is that RB has centrilobular findings while RB ILD has centrilobular changes and ground glass changes and DIP has centrilobular findings ground glass changes and cysts.
A “smoker’s macrophage”, with yellow to light brown and finely granular cytoplasmic pigment. Courtesy Wiki web lungs 437
Photomicrograph (original magnification, x100; hematoxylin-eosin stain) showing the characteristic histologic features of RB-ILD. Pigmented macrophages in a terminal bronchiole and the adjacent alveoli (arrows), and moderate peribronchiolar inflammation and fibrosis (arrowhead) are present. *Mueller-Mang C, Grosse C, Schmid K, et al.: What every radiologist should know about idiopathic interstitial pneumonias. Radiographics 2007, 27:595?615. Prior permission from The Radiological Society of North America.Sieminska A, et al Respiratory bronchiolitis-interstitial lung disease Orphanet Journal of Rare Diseases volume 9 : 106 (2014 )
Macrophages, wall and lumen of bronchiole, and centrilobular nodules
Histopathology of respiratory bronchiolitis: Smoker’s macrophages (arrow); mild interstitial lymphocytic infiltrate and mild fibrosis (arrowhead)[Courtesy Wiki web lungs 438
Axial HRCT shows ill-defined centrilobular ground-glass nodules image in the upper lobes. The patient had a mild cough and dyspnea with exercise.Courtesy Radiology Key
Coronal HRCT reconstruction shows faint centrilobular nodules image in the upper lobes sparing the lower lung zones in this asymptomatic patient with a 40 pack-year smoking history. Courtesy Radiology key
High-resolution computer tomography in respiratory bronchiolitis-associated interstitial lung disease. Bronchiolocentric interstitial ground-glass opacifications, accentuated in the upper part of the lung.Smoking-Related Interstitial Lung Disease January 2015Deutsches Ärzteblatt International 112(4):43-50 Hagmeyer L et al
RB-ILD in a 32-year-old man with a 17 pack-year history of smoking who presented with a cough, restrictive PFT results, and reduced diffusion capacity. (a) High-resolution CT image obtained through the upper lungs shows bilateral centrilobular ground-glass nodules (arrow).Attili, A.K etal Smoking-related Interstitial Lung Disease: Radiologic-Clinical-Pathologic Correlation RadioGraphics Vol. 28, No. 5 2008
Photomicrograph of a surgical lung biopsy specimen shows a bronchiolocentric collection of pigmented macrophages (arrow).Attili, A.K etal Smoking-related Interstitial Lung Disease: Radiologic-Clinical-Pathologic Correlation RadioGraphics Vol. 28, No. 5 2008
Histopathology characterized by
pigmented macrophages and
respiratory bronchioles and alveoli
mild interstitial inflammatory
alveolar septa in the peribronchial may be mildly thickened
no significant fibrosis
DIP is similar to RB-ILD,
DIP and RB-ILD are a spectrum
differing in compartments involved
DIP not bronchiolocentric.
hyperplasia of the alveolar type II cells
distribution pattern more homogeneous a
mild peribronchial fibrosis
Buzz
Use your words
respiratory bronchiolitis = inflammation of the respiratory bronchioles.
dirty lung appearance
centrilobular lung nodules
ground glass
air trapping
emphysema
Respiratory Bronchiole
The diagram shows the structure of the airways and alveoli at the level of the secondary lobule. The terminal bronchiole (tb- pink) enters the secondary lobule and terminates in the respiratory bronchiole (rb – purple) which lies in the center of the the secondary lobule (centrilobular). It gives rise to the alveolar duct (ad, yellow)which gives rise to the alveolar sac (as, teal blue. Finally the alveolar sac terminates in the alveoli (a white). Courtesy Ashley Davidoff MD lungs-0028-low res
The arteriole and bronchiole lie in the center of the lobule. Pulmonary venules (red) and lymphatics (yellow). lie in the periphery of the lobule 42440b03 Davidoff Art Courtesy Ashley Davidoff MD
Secondary Lobule
Inhalation – Upper Lobes
centrilobular ground glass nodules
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