Obliterative bronchiolitis (OB), 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. OB should not be confused with bronchiolitis obliterans organizing pneumonia (BOOP).
Recognized associations include:
- inflammatory bowel disease
- 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
- Swyer-James syndrome 13
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 number of causes:
- post viral (e.g. adenovirus)
- post atypical infection (e.g. Mycoplasma pneumonia)
- noxious fume inhalation
- neuroendocrine hyperplasia (pulmonary tumourlets) 4
- post-transplant patients
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 oligaemia. This combination can give a mosaic attenuation pattern. Other features include:
History and etymology
It was first described by the French physician AC Reynaud in 1835 8,9.
- 1. Skeens JL, Fuhrman CR, Yousem SA. Bronchiolitis obliterans in heart-lung transplantation patients: radiologic findings in 11 patients. AJR Am J Roentgenol. 1989;153 (2): 253-6. AJR Am J Roentgenol (abstract) - Pubmed citation
- 2. Worthy SA, Park CS, Kim JS et-al. Bronchiolitis obliterans after lung transplantation: high-resolution CT findings in 15 patients. AJR Am J Roentgenol. 1997;169 (3): 673-7. AJR Am J Roentgenol (abstract) - Pubmed citation
- 3. Lentz D, Bergin CJ, Berry GJ et-al. Diagnosis of bronchiolitis obliterans in heart-lung transplantation patients: importance of bronchial dilatation on CT. AJR Am J Roentgenol. 1992;159 (3): 463-7. AJR Am J Roentgenol (abstract) - Pubmed citation
- 4. Brown MJ, English J, Müller NL. Bronchiolitis obliterans due to neuroendocrine hyperplasia: high-resolution CT--pathologic correlation. AJR Am J Roentgenol. 1997;168 (6): 1561-2. AJR Am J Roentgenol (citation) - Pubmed citation
- 5. Pipavath SJ, Lynch DA, Cool C et-al. Radiologic and pathologic features of bronchiolitis. AJR Am J Roentgenol. 2005;185 (2): 354-63. AJR Am J Roentgenol (full text) - Pubmed citation
- 6. Markopoulo KD, Cool CD, Elliot TL et-al. Obliterative bronchiolitis: varying presentations and clinicopathological correlation. Eur. Respir. J. 2002;19 (1): 20-30. Eur. Respir. J. (link) - Pubmed citation
- 7. Gunn ML, Godwin JD, Kanne JP et-al. High-resolution CT findings of bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation. J Thorac Imaging. 2008;23 (4): 244-50. doi:10.1097/RTI.0b013e3181809df0 - Free text at pubmed - Pubmed citation
- 8. Gosink BB, Friedman PJ, Liebow AA. Bronchiolitis obliterans. Roentgenologic-pathologic correlation. Am J Roentgenol Radium Ther Nucl Med. 1973;117 (4): 816-32. Am J Roentgenol Radium Ther Nucl Med (abstract) - Pubmed citation
- 9. Reynaud AC. Memoire sur l’obliteration des bronches. Acad. Med., Paris, 1835, 4, 117-167.
- 10. Wah TM, Moss HA, Robertson RJ et-al. Pulmonary complications following bone marrow transplantation. Br J Radiol. 2003;76 (906): 373-9. Br J Radiol (full text) - doi:10.1259/bjr/66835905 - Pubmed citation
- 11. Yam LY, Wong R. Bronchiolitis obliterans and rheumatoid arthritis. Report of a case in a Chinese patient on d-penicillamine and review of the literature. Ann. Acad. Med. Singap. 1993;22 (3): 365-8. Pubmed citation
- 12. Devouassoux G, Cottin V, Lioté H et-al. Characterisation of severe obliterative bronchiolitis in rheumatoid arthritis. Eur. Respir. J. 2009;33 (5): 1053-61. doi:10.1183/09031936.00091608 - Pubmed citation
- 13. Brant WE, Helms CA. Fundamentals of Diagnostic Radiology. Lippincott Williams & Wilkins. (2007) ISBN:0781761352. Read it at Google Books - Find it at Amazon
- 14. Aguilar PR, Michelson AP, Isakow W. Obliterative Bronchiolitis. (2016) Transplantation. 100 (2): 272-83. doi:10.1097/TP.0000000000000892 - Pubmed