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Chest Imaging

Respiratory bronchiolitis

(also called smoker's bronchiolitis), disease that is extremely common in cigarette smokers, this disorder is usually mild, the majority of patients being asymptomatic. Respiratory bronchiolitis primarily affects respiratory bronchioles, but inflammatory changes may also be seen in terminal bronchioles. Mild chronic inflammation is found in the wall of respiratory bronchioles, associated with slight fibrosis, smooth muscle hypertrophy and thickening of the adjacent alveolar walls. The most characteristic features is the accumulation of tan-brown macrophages in the lumina of respiratory bronchioles and the adjacent alveoli. Most commonly respiratory bronchiolitis is seen as an incidental finding. It may rarely be sufficiently extensive in its involvement of lung tissue to cause mild interstitial lung disease (or respiratory bronchiolitis associated interstitial lung disease). Rarely, particularly in heavy smokers, the condition may be severe enough to produce symptoms such as cough or dyspnoea and/or lead to abnormalities on HRCT scans.

The HRCT findings include ill-defined centrilobular nodular opacities (see centrilobular nodules), attributed to the bronchiolar inflammation, and patchy areas of ground glass attenuation, attributed to smoker's alveolitis (Fig.1). The changes have a predominantly upper lobe distribution. The changes show no further progression or resolve slowly if smoking is stopped. Air trapping may also be present.

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Fig.1

HRCT scan in a heavy smoker manifesting cough and dyspnoea, shows bilateral small ill-defined centrilobular nodules predominantly distributed in the upper lobes. Centrilobular emphysema and patchy areas of ground-glass opacity were also present.
Respiratory bronchiolitis, Fig.1