Bronchiolitis - BRONCHOLAR DISEASES DR.BASANTA HAZARIKA...

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Unformatted text preview: BRONCHOLAR DISEASES DR.BASANTA HAZARIKA DEPT OF PULMONARY & CRITICAL CARE MEDICINE PGIMER, CHANDIGARH Anatomy Of Bronchioles ¡ Diameter is about 1 to 2 mm ¡ Cartilage are absent ¡ Directly embedded in the lung parenchyma ¡ Caliber influenced by lung volume ¡ Nutrition by bronchial circulation ¡ Normal bronchioles (0.6mm) not visible on CT Historical Background ¡ Bronchiolitis recognized since 1800 ¡ BO first described by Reynaud 1835 ¡ Wilhelm Lange coined term bronchiolitis in 1901 ¡ Franenkel in 1902 described histopathology of BO due to NO2 ¡ Term BOOP was used since 1985 ¡ Last two decades HRCT has greatly contributed. Classification There are four classification schemes commonly used ¡ Clinical classification ¡ Histological classification ¡ HRCT findings ¡ Clinico-pathological Clinical Classification 1. Inhalation injury 2. Post infectious * Acute bronchiolitis * Bronchiolitis obliterans 3. Drug-induced reaction 4. Idiopathic * Not associated disease * Associated with organ transplantation * Associated with CTD * Other rare associations (Penn.CC et al Clin Chest Med 1993;14:645-654) Histological Classification 1. Cellular bronchiolitis Follicular b., Respiratory b., Diffuse panbronchiolitis 2. Bronchiolitis with inflammatory polyps or intraluminal polyps BOOP 3. Constrictive (cicatrial) bronchiolitis hyperplasia and bronchiolar fibrosis particle-induce small airways disease 4. Pan-bronchiolar fibrosis and bronchiolar metaplasia (lambertosis ) (Venerino.p Resp.Crit Care Med. 2003;24:1-13) HRCT Classification 1. Centrilobular nodular and branching lines (tree-in-bud) 2. Ground glass attenuation and/or alveolar consolidation 3. Low attenuation (Mosaic perfusion) and expiratory air trapping 4. Mixed or different pictures (Muller NL,et al Radiology 1995;196:3-12) Clinico-pathological Primary bronchiolar disease Respiratory B., Acute B. Constrictive B., Follicular B. Diffuse Pan B., Mineral dust airway disease Other primary bronchiolar disease Bronchiolar involvement in ILD Respiratory bronchiolitis associated with ILD/DIP Organizing pneumonia(BOOP,proliferative B.) Hypersensitivity pneumonitis Other ILD(PLCH,Sarcoidosis,IPF) Broncholitis involving large airway disease Ch.Bronchitis,Bronchiectasis, Asthma (Ryu JH et al-Am J. Resp Crit. Care Med 2003;168:1277-1292) Pathogenesis Histopathology patterns of bronchiolitis related to ¡ Type of insult ¡ Extent and severity of the initial insult ¡ Predominate site of injury (Bronchioles, AD or both) INSULT Injury/destruction of small airway Epithelium Acute and chronic inflammatory responses Repair by proliferation of granulation tissue Intramural and intraluminal fibrosis Airway obliteration Diagnosis Of Bronchiolar Disease ¡ History ¡ Chest examination= Wheezing, or crepitation....
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This note was uploaded on 12/03/2011 for the course MEDICINE 350 taught by Professor Dr.aslam during the Winter '07 term at Medical College.

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Bronchiolitis - BRONCHOLAR DISEASES DR.BASANTA HAZARIKA...

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