Jou rn al of the Korean Radiological Society, 1994; 30 (6) : 1039 - 1044 Bronchiectasis in Diffuse Panbronchiolitis: High Resolution CT Assessment1 Kun 11 Kim, M.D., Ki Nam lee2, M.D., Jae Ryang Juhn3, M .D. , Woo Hyun Ahn4, M.D., Soon Kew Park5, M.D., Byung Soo Kim, M .D . Purpose: To evaluate the characteristics of the bronchiectasis in diffuse panbronchiolitis using HRCT. Materials and Methods: We retrospectively studied 12 H RCT scans and two bronchography of 12 patients with diffuse panbronchiolitis(DPB). According t 。 Akira et al., DPB was classified into four types: small nodules around the end of bronchovascular branchings(CT type 1), small nodules in the centrilobular area connected with small branching linear opacities(CT type 11). nodules ac­ companied by ring -shaped or small ductal opacities connected to proximal bronchovascular bundles(CT type 111). large cystic opacities accompanied by dilated proximal bronchi( CT type IV). We compared the type and the extent of bronchiectasis, CTtypes of DPB, and pulmonary function test. Results: Bronchiectasis was defined in 12 cases with the tubular type predominantly involving small and medium-sized bronchi. These bronchiectasis involved the proximal bronchi of the centrilobular lesions of DPB. Among eight cases of advanced DPB(CT type 111 & IV) which extended to both upper lobes, seven showed tu bu lar bronchiectasis at the same area. Cystic bronchiectasis was shown in eight cases predominantly involving right middle lobe(n=7) . There was no linear correlation between the values of p 비 mona ry function test and CT types of DPB. Conclusion: Characteristic feature of the bronchiectasis in DPB is the tubular ectasis predominantly involving the small and medium -sized bronchi.DPB with associated tubular bronchiectasis can involve whole lung field in advanced cases. HRCT is useful not only to depictthe findings of DPB but also to demonstrate the extent of lesion. Index Words: Bronchiectasis Bronchiolitis Lung ,CT Computed tomog raphy( CTl , h i 9 h-resol uti on Diffuse panbronchiolitis(DPB) is a chronic inflamma­ airflow limitation ; and histologically by typical bron­ tory disease ofthe respiratory bronchioles of unknown chiolar lesions(1). Chest radiograph and high resol­ etiology characterized clinically by chronic cough, ex­ ution CT have shown specific findings of the bron­ pectoration , and dyspnea; physiologically by chronic chiolar lesions(2, 3). However, recent studies have shown that DPB cau­ ‘Department of Diag nostic Radiology. Coll ege of Medicine. Pusan National Uni ses inflammation and dilatation of not only the bron­ versi ty chioles but also the bronchi(4-7). Although there is no 2Depa rtemen tof Diag nos itic Radio logy, Coll ege of Med icin e, Do ng-AUni ve rsity doubt that the major pathologic findings are present in 3Depa rtment ofD iagnostic Radio logy , Col lege of Medicin e, Inje University and around the bronchi 이 ar walls, it is not known ' De partment ofRadiology, Wallace Memorial Hospital 5Department of Internal Medicine , Coll ege 이 Medicine, Pusan National Unive r­ whether the repiratory bronchioles are primarily or sity secondarily affected(8). Furthermore, the relationship Rece ived december13 , 1993 ; Accepted April7 , 1994 of DPB to bronchiectasis, if there is any, remains to be Add ress reprin t requests to:K un- II Kim, M.D., Department of Rad iology , Col lege of Medicine , Pusan National Uni versity í 1-10, Am i-dong , Seo-gu, Pusan, elucidated(7) . 602-739 Korea , Tel (051) 240 - 7373 Fax. (051) 244 -7534 We began this study to find the characteristics of 1039 - Journ al of the Korean Radiologica l Society, 1994 : 30 ( 6) : 1039-1044 the bronchiectasis in DPB and to determine if there is in diffuse panbronchi 이 itis with assessment of the any suggestion about the nature of the airway disease findings of HRCT. Table 1. Summ ary 0112 Pati ents with Diffuse Panbronchiolitis Bronchiectasis Case PFT CT Extent Sizeol Age/Sex ABGA type* 。 IDPB site type bronchi Others U * + RML tubular La * - FEVl :39 % 1.57 / F 3 / 2 * M * ++ Ls * tubular Me * + + 17 years * FVC :34 % L *+ + + BLL tubu lar Sm * + + + U++ La + FEVl : 27 % Whole * tubular Bronchography 2. 33 1 M 4 13 M + ++ Me ++ FVC :40% RML cystlc 13 years L+++ Sm ++ + FEVl : 58 % U- Ls tubular La - Bronchography 3. 21 / M FVC : 62 % 2 / 1 M+ BLL tubular Me ++ RML lobectomy Pa02 :65% L ++ RML cystic Sm ++ 10 years U + + La - Pseudomonas Pa0 2 :38 % Whole tubular 4. 48 1 F 4 / 4 M + + Me ++ Inlection PFTNA * RML cystic L + ++ Sm +++ 20 years U + La - FEVl : 61 % Whole tubular 5. 24 1 F 3 / 2 M + Me + 8 years FVC: 65 % RML cystic L ++ Sm + ++ U- RML tubular La - FEVl ’ 58 i 6. 42 / M ’ 2 13 M + LLL tubular Me ++ 20years FVC ‘ 64 % L +++ LLL cystic Sm ++ U + Whole tubul ar La - FEVl : 55 % 7.32 / F 3 12 M ++ RML cystic Me+ + 20 years FVC : 60 % L +++ RML varlcose Sm ++ U- La - FEVl ‘ 49 % 2 / 3 Pathologic DPB 8. 26 1 M M- RLL tubular Me + FVC ’ 54 % Rt ) Lt * 15 years L +++ Sm + U ++ La - FEVl : 25 % Whole tubular 9. 20 1 M 4 14 M + ++ Me + 8 years FVC :31 % RML cystic L+++ Sm ++ + U- La - FEVl : 52 % 2/3 10. 20 1 F M+ LLL tubular Me + 7 years FVC: 47 % Lt ) Rt * L ++ Sm + FEVl : 42 % U + + La - 11 . 51 1 F FVC : 51 % 4 / 4 M ++ Whole tubular Me + 3 years Pa02 :63% L ++ + Sm + U + + Whole tubular La - FEVl : 66 % 12. 26 1 F 3 / 4 M ++ + RML cystic Me + 9 years FVC : 62 % L +++ RUL cystic Sm + Abb reviations * U, M, L : Upper, Middle, Lower lung lield * La, Me, Sm ,: Large, Medium , Small-sized bronchi * Ls : Lingular segment BLL : both lower lobes * Whole: Whole lobes * Years Duration 01 sym ptoms such as productive coughing and exertional dyspnea * NA : Not Applicable due to severe dyspnea * Rt ) Lt, Lt ) Rt : Right or Left predominant inv 이 vement 01 lung * +, + + , + + +: mild, moderate, severe involvement * CT type 1: small nodules around the end 01 bronchovascular branchings CTtype 11 : small nodules in the centrilobular area connected with small branching linear opacities CT type 111 : nodules accompanied by ring-shaped or small ductal opacities connected to proximal bronchovascular bundles CT type IV : large cystic opacities accompanied by dilated proximal bronchi * CT type 3/2: Predominant CT type/Subsidiary CT type - 1040 - Kun 11 Kim , et al : Bronchiectasi s in Diffuse Panbronchi 이 itis dium -sized bronchi. These bronchiectasis involved MATERIALS and METHODS the proximal bronchi of the centrilobular lesions of DPB . In two cases of unilateral predominant involve­ The study group consisted of 12 patients(tive men ment of DPB , ipsilateral involvement of tubular and seven women) , who ranged in age from 20 to 57 bronchiectasis and thickening of bronchial wall were years(mean 33 years). The diagnosis was based on the found(one in the left lower lobe, the other in the right cl inical , functional , and radiologic criteria of Homma et lower lobe). Among the eight cases(CT type 111 and IV) al (1) and HRCT(Table 1). AII cases had chronic pan­ involving both upper lung fields with DPB , seven cases sinusitis. Pseudomonas aeruginosa was detected con­ showed tubular bronchiectasis. Tubular bronchiecta­ tinuously in the sputum of one case. Histologic proof sis was not found in the lobar or segmental area which was obtained by means of open lung biopsy in one was not involved with bronchiolar lesion case. The CT scans were obtained on a Somatom Plus In addition , there were cystic bronchiectases in eight S(Siemens) and GE 9800(General Electric) with 1.0 to cases predominantly involving right middle 10be(RML) 1.5 mm collimation at 1.5-2.0 cm interval from the (n =7) (Fig. 2). Other sitesof cystic bronchiectasis were apex to the base ofthe lung during breath holding after left lower 10be(LLL) in one case and right upper lobe full inspiration. A high spatial frequency algorithm was (RU L) anterior segment in another( combined RML used for all patients. The high - resolution images were lesion). The cases with cystic bronchiectasis had CT displayed at window levels appropriate for pulmonary type 11 in two, CT type 111 in three, and CT type IV in three parenchyma (1000-15001 -700 - -600). In two cases, cases. Large bronchi were involved with tubular we reviewed the bronchography films taken one year bronchiectasis only in one case, but all cases(n=12) before the diagnosis of DPB. Two diagnostic radio­ showed thicken ing of the bronchial wall. log ists were participated in reading of the HRCT films. In two cases, previous bronchography showed mild The CT findings of DPB were graded with CT types tubular bronchiectasis at the medium - sized bronchi , reported by Akira et aI( 2) . Several CT types seen bronchiolectasis, stenosis of long segment of small concurrently in each case were categorized using airways, tapered obstruction ofthe small and medium slash(Predominant CT type/Subsidiary CT type, e. g. sized bronchi , and absence of the acinar filling in the CT type 111/11). The extent of the involvement of DPB was involved area. (Fig. 2, 4) divided to upper, middle and lower third lung field. We There was no linear correlation between CT types observed the laterality of the lesions. Bronchiectasis and FEV1 %(p= -0.526, p=0.09) , % FVC(p= -0.477, and the thickening of the bronchial wall were assessed p=0.13) , and FEV1 IFVC(p= -0.481 , p=0.13) though according to the size ; large(main stem , lobar, and seg­ there was a tendency that the values of pulmonary mental bronchi) , medium, and small(within the range function test decreased as CT type increased.