Diffuse Panbronchiolitis:Clinical Significance of High-resolution CT and Radioaerosol Scan Manifestations.

Song, So Hyang; Kim, Hui Jung; Kim, Young Kyoon; Moon, Hwa Sik; Song, Jeong Sup; Park, Sung Hak; Kim, Hak Hee; Chung, Soo Kyo

doi:1997.44.1.124

Tuberc Respir Dis > Volume 44(1); 1997 > Article

Original Article

Tuberculosis and Respiratory Diseases 1997;44(1):124-135.
DOI: https://doi.org/10.4046/trd.1997.44.1.124 Published online February 1, 1997.

Diffuse Panbronchiolitis:Clinical Significance of High-resolution CT and Radioaerosol Scan Manifestations.

So Hyang Song, Hui Jung Kim, Young Kyoon Kim, Hwa Sik Moon, Jeong Sup Song, Sung Hak Park, Hak Hee Kim, Soo Kyo Chung

¹Department of Internal Medicine, Catholic University Medical College, Seoul, Korea.
²Department of radiology, Catholic University Medical College, Seoul, Korea.

Abstract

BACKGROUND
Diffuse panbronchiolitis(DPB) is a disease characterized clinically by chronic cough, expectoration and dyspnea; and histologically by chronic inflammation localized mainly in the region of the respiratory bronchiole. It is prevalent in Japanese, but is known to be rare in Americans. and Europians. Only few cases in Chinese, Italians, North Americans and Koreans have been reported. It is diagnosed by characteristic clinical, radiological and pathologic features. High-resolution CT(HRCT) is known to be valuable in the study of the disease process and response to therapy in DPB. To our knowledge, there has been no correlation of its appearance on HRCT with the severity of the disease process, and radioaerosol scan(RAS) of the lung has not previously been used for the diagnosis of DPB. METHOD: During recent two years we have found 12 cases of DPB in Kangnam St. Mary's Hospital, Catholic University Medical College. We analysed the clinical characteristics, compared HRCT classifications with clinical stages of DPB, and determined characteristic RAS manifestations of DPB. RESULTS: 1. The ages ranged from 31 to 83 years old(mean 54.5 years old), and male : female ratio was 4:8. 75%(9/12) of patients had paranasal sinusitis, and only one patient was a smoker. 2. The patients were assigned to one of three clinical stages of DPB on the basis of clinical findings, sputum bacterology and arterial blood gas analysis. Of 12 cases, 5 were in the first stage, 4 were in the second stage, and 3 were in the third stage. In most of the patients, pulmonary function tests showed marked obstructive and slight restrictive impairments. Sputum culture yielded P. aeruginosa in 3 cases of our 12 cases, K. pneumoniae in 2 cases, H. influenzae in 2 cases, and S. aureus in 2 cases. 3. Of 12 patients, none had stage I characteristics as classified on HRCT scans, 4 had stage II findings, 5 had stage III findings, and 3 had stage IV characteristics. 4. We peformed RAS in 7 of 12 patients with DPB. In 71.4% (5/7) of the patients, RAS showed mottled aerosol deposits characteristically in the transitional and intermediary airways with peripheral airspace defects, which contrasted sharply with central aerosol deposition of COPD. 5. There were significant correlations between HRCT stages and clinical stages(r=0.614, p<0.05), between HRCT types and PaO2(r=-0.614, p<0.05), and between HRCT types and ESR(r=0.618, p<0.01). CONCLUSION: The HRCT classifications correspond well to the clinical stage. Therfore in the examination of patients with DPB, HRCT is useful in the evaluation of both the location and severity of the lesions. Also, RAS apears to be a convenient, noninvasive and useful diagnostic method of DPB.