20 Constrictive Bronchiolitis
20.1 What this covers
- Pathology
- Presentation
- Workup
20.2 Learning objectives
- Pathology
- Presentation
- Workup
20.3 Bottom line / summary
- https://www.nejm.org/doi/full/10.1056/nejmoa1101388
- Membranous bronchioles develop mural smooth muscle hypertrophy or fibrous thickening with luminal narrowing.
- Non-specific respiratory symptoms and exercise limitation
- Imaging: shows air trapping on expiratory films in about 1/4.
- However, normal imaging findings occur in the majority due to the absence of alveolar disease
20.4 Approach
- Burn pit exposures / Iraq service
- inhalation exposure to: Nitrogen dioxide, sulfur dioxide, inorganic dust, fly ash, and diacetyl (popcorn)
- Post-transplant
- Rheumatologic conditions
20.5 Red flags / when to escalate
- TODO: List red flags that require urgent escalation.
20.6 Common pitfalls
- TODO: Capture common errors or missed steps.
20.7 References
- https://www.nejm.org/doi/full/10.1056/nejmoa1101388
20.8 Source notes
20.8.1 Constrictive Bronchiolitis
21 Constrictive Bronchiolitis
https://www.nejm.org/doi/full/10.1056/nejmoa1101388
21.1 Pathology
Membranous bronchioles develop mural smooth muscle hypertrophy or fibrous thickening with luminal narrowing.
21.2 Presentation
Patient factors
- Burn pit exposures / Iraq service
- inhalation exposure to: Nitrogen dioxide, sulfur dioxide, inorganic dust, fly ash, and diacetyl (popcorn)
- Post-transplant
- Rheumatologic conditions
Non-specific respiratory symptoms and exercise limitation
21.3 Workup
Imaging: shows air trapping on expiratory films in about 1/4. However, normal imaging findings occur in the majority due to the absence of alveolar disease
May have either obstruction or restriction on PFTs - though these are not required for the diagnosis
Diagnosed on lung biopsy