Chest
Clinical Investigations: Imaging: ArticlesReversible Airway Lesions in Diffuse Panbronchiolitis: Detection by High-Resolution Computed Tomography
Section snippets
Subjects and Study Design
We evaluated 18 patients with DPB, 10 men and 8 women, aged 18 to 69 years (average, 47.0±3.4 years). All patients had been diagnosed as having DPB according to criteria of the Ministry of Health and Welfare of Japan.7 The histologic diagnosis of DPB was confirmed in 14 patients by transbronchial or open lung biopsy specimen. None of the patients showed an increase in FEV1 greater than 15% after the inhalation of a bronchodilator.
All patients were evaluated by pulmonary function tests,
Pulmonary Function Tests
Pretherapy spirometric tests showed a restrictive ventilatory defect in seven cases, an obstructive defect in one case, a combined defect in four cases, and nearly normal ventilation in six cases. Blood gas analysis revealed hypoxemia in all cases (PaO2, 54.9 to 84.5; mean, 70.8±1.7 mm Hg). The FVC, FEV1, and PaO2 all increased significantly after erythromycin therapy: FVC, 2.35±0.25 to 2.83±0.28 L, p<0.01; FEV1, 1.68±0.20 to 2.01±0.24 L, p<0.01; PaO2 70.8±1.7 to 82.4±3.0 mm Hg, p<0.01 (Table 2
Discussion
The identification of specific and more clinically relevant pathologic changes in pulmonary diseases has been made possible by CT and especially by HRCT.9, 11, 12, 13 The usefulness of HRCT in the evaluation of both the location and severity of the lesions is well documented in patients with DPB.6 However, this approach had not been used for objective evaluation. We therefore attempted to score the HRCT findings clinically relevant to the pathologic findings in patients with DPB to objectively
References (22)
- et al.
Diffuse panbronchiolitis: a disease of the transitional zone of the lung
Chest
(1983) - et al.
Neutrophilia in bronchoalveolar lavage fluid of diffuse panbronchiolitis
Chest
(1990) Chest radiographic findings in the adult with cystic fibrosis
Semin Roentgenol
(1987)Clinical management of pulmonary disease in cystic fibrosis
Lancet
(1993)- et al.
Analysis of HLA antigens in patients with diffuse panbronchiolitis
Am Rev Respir Dis
(1990) - et al.
Long-term therapeutic effects of erythromycin and new quinolone antibacterial agents on diffuse panbronchiolitis
Jpn J Thorac Dis
(1990) - et al.
Erythromycin reduces neutrophils and neutrophil-derived elastolytic-like activity in the lower respiratory tract of bronchiolitis patients
Am Rev Respir Dis
(1992) - et al.
Diffuse panbronchiolitis: evaluation with high-resolution CT
Radiology
(1988) Definition of diffuse panbronchiolitis
Jpn Intern Med
(1976)- et al.
Spirometric studies in normal subjects: I. Forced expirograms in subjects between 7 and 70 years of age
Acta Med Scand
(1963)
Bronchiectasis: assessment by thin section CT
Radiology
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2008, Clinics in Chest MedicineCitation Excerpt :CT may help monitor the course of patients who have diffuse panbronchiolitis. On serial evaluation in untreated patients [37], centrilobular nodules progress, with development of bronchiolectasis and bronchiectasis; conversely, in patients treated with erythromycin, the nodules decrease in size and number, though areas of decreased attenuation may persist (see Fig. 11) [37,38]. Bronchiolectasis also improves on treatment, but bronchiectasis does not change significantly [39].
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