Small airway diseases are seen in many clinical conditions. The locations of small airway diseases are small bronchioles including terminal and respiratory bronchioles, and alveolar duct. The histopathologic features of bronchiolar injury have been described variously and have led to confusing and overlapping terms. The purpose of this article is to describe the clinical characteristics and histopathologic interpretation of small airway diseases. We classify the small airway diseases as primary bronchiolar diseases, and secondary bronchiolar diseases including pulmonary parenchymal diseases, and large airway diseases with prominent bronchiolar involvement. Primary bronchiolar diseases include respiratory bronchiolitis, acute bronchiolitis, constrictive bronchiolitis, follicular bronchiolitis, diffuse panbronchiolitis, mineral dust airway diseases, and a few other variants. Pulmonary parenchymal diseases with bronchiolar involvement include respiratory bronchiolitis-associated interstitial lung disease, organizing pneumonia, hypersensitivity pneumonitis, pulmonary Langerhans' cell histiocytosis, sarcoidosis and idiopathic pulmonary fibrosis. Bronchiolar changes can also be seen in large airway diseases such as chronic bronchitis, bronchiectasis, cystic fibrosis and asthma. The patterns of bronchiolar response to various injuries are relatively limited and these patterns are generally non-specific in regard to the etiology. Appropriate interpretation and diagnosis of small airway diseases depend on judicious correlation of clinical, radiologic, and histopathologic characteristics.
Alveolitis, Extrinsic Allergic ; Asthma ; Bronchiectasis ; Bronchioles ; Bronchiolitis ; Bronchiolitis Obliterans ; Bronchitis, Chronic ; Cystic Fibrosis ; Diagnosis ; Dust ; Histiocytosis ; Idiopathic Pulmonary Fibrosis ; Lung Diseases, Interstitial ; Pneumonia ; Sarcoidosis

Aspergillus is a ubiquitous fungus which is found in soil, composed piles, and even in the air. It causes various clinical syndromes, which are mainly determined by the immunocompetence of host; simple colonization in normal person, aspergilloma in patients with lung cavities (e.g. after tuberculosis), chronic necrotizing pneumonia in mildly immunocompromised hosts (e.g. DM or alcoholics) or those who have chronic lung diseases, invasive aspergillosis which is severe and commonly fatal in immunocompromised patients. It may cause hypersensitivity reaction; IgE-mediated asthma, hypersensitivity pneumonitis (extrinsic allergic alveolitis), allergic Aspergillus sinusitis, allergic bronchopulmonary aspergillosis (ABPA). It is essential for clinicians to be familiar with the spectrum of Aspergillus-related clinical syndromes. After a brief review of each clinical syndrome, ABPA that is a typical allergic disease was reviewed in detail.
Alveolitis, Extrinsic Allergic ; Aspergillosis ; Aspergillosis, Allergic Bronchopulmonary ; Aspergillus ; Asthma ; Colon ; Fungi ; Humans ; Hypersensitivity ; Immunocompetence ; Immunocompromised Host ; Lung ; Lung Diseases ; Pneumonia ; Pulmonary Aspergillosis* ; Sinusitis ; Soil

The first case of allergic bronchopulmonary aspergillosis(ABPA) was reported by Hinson, et al. in 1952. This was followed by a number of significant description of the disorder. Although typical ABPA initially presents with asthma, fleeting pulmonary infiltrates, and marked eosinophilia, there are many other ways in which the disease may be first manifested. Common radiologic findings in ABPA include pulmonary infiltrates, atelectasis, emphysema, fibrosis, lobar shrinkage with hilar elevation, cavitation, pneumothorax, aspergilloma and central bronchiectasis. We experienced a case of allergic bronchopulmonary aspergillosis presenting rare radiologic finding of bilateral pulmonary masses in chest radiography. With oral corticosteroid treatment, the size of both pulmonary masses was decreased significantly and his asthmatic symptoms were improved.
Aspergillosis, Allergic Bronchopulmonary* ; Asthma ; Bronchiectasis ; Emphysema ; Eosinophilia ; Fibrosis ; Pneumothorax ; Pulmonary Atelectasis ; Radiography ; Thorax

BACKGROUND: Open lung biopsy(OLB) has conventionally been regarded as the gold standard for the diagnosis in interstitial lung disease. With recent advances in diagnostic technique such as high resolution computed tomography(HRCT), and transbronchial lung biopsy(TBLB) which provide relatively accurate diagnosis of ILD, it is necessary to reevaluate the role of these methods in the diagnosis of ILD. METHODS: We carried out a retrospective analysis of nineteen patients who underwent OLB at Dankook University Hospital for the diagnosis of acute and chronic ILD, between May 1995 and June 1998. By reviewing the medical records, the demographic findings, underlying conditions, HRCT and TBLB findings, OLB diagnosis, therapy after OLB, and complication of OLB were evaluated. RESULTS: 1) Thirteen patients(68.4%) had chronic ILD(symptom duration over 2 weeks prior to OLB), and six patients(31.6%) had acute ILD(symptom duration less than 2 weeks). 2) Specific diagnosis were reached in 92%(12/13) of chronic ILD(5 Bronchiolitis obliterans organizing pneumonia(BOOP), 2 constrictive bronchiolitis, 3 Usual interstitial pneumonia, 1 hypersensitivity pneumonitis, 1 eosinophilic pneumonia), and in all patients of acute ILD(5 acute interstitial pneumonia, 1 pneumocystis carinii pneumonia). 3) HRCT were performed in all patients and a correct first choice diagnosis rate of HRCT was 42%(5/12) in chronic ILD. 4) In chronic ILD patients, 62%(8/13) received specific therapy(steroid therapy in 7 patients and moving in one patient), after OLB, but in acute ILD, all patients received specific therapy(steroid therapy in 5 patients and steroid and antibiotic therapy in one patient) after OLB. 5) The in-hospital mortality after OLB was 5.3%(1/19). CONCLUSION: OLB is an excellent diagnostic technique with relatively low complications in patients with ILD. Therefore OLB should be considered in patients with ILD when the specific diagnosis is important for the treatment, especially in patients with acute ILD.
Alveolitis, Extrinsic Allergic ; Biopsy* ; Bronchiolitis Obliterans ; Diagnosis* ; Eosinophils ; Hospital Mortality ; Humans ; Idiopathic Pulmonary Fibrosis ; Lung Diseases, Interstitial* ; Lung* ; Medical Records ; Pneumocystis carinii ; Retrospective Studies

No abstract available.
Allergens ; Food Hypersensitivity ; Asthma ; Invasive Pulmonary Aspergillosis ; Aspergillosis, Allergic Bronchopulmonary

OBJECTIVETo understand the clinical characteristics of allergic bronchopulmonary aspergillosis (ABPA) so as to diagnose and treat the disease earlier.

METHODA retrospective study was conducted on ABPA patients diagnosed in the Second Department of Respiratory Medicine, Beijing Children's Hospital Affiliated to Capital Medical University from April 2010 to March 2014. The literature of children's ABPA retrieved from the databases at home and abroad in recent 10 years were analyzed.

RESULT(1) Among the 4 cases of ABPA, cystic fibrosis (CF) and asthma were diagnosed in 2 and 1 cases, respectively. Cough was present in 3 patients, recurrent wheezing in 2 and chest tightness in 1 case. CT scans showed central bronchiectasis in all 4 cases, while 1 patient had migratory shadows. All cases had elevated serum total IgE, immediate cutaneous reaction to aspergillus fumigatus; A. fumigatus-specific IgE and IgG were positive in 4 cases. The diagnosis of the 4 cases was confirmed according to the history, radiologic investigations and laboratory findings. All of them were improved after the treatment with glucocorticosteroid and antifungal agents (voriconazole or itraconazole). (2) We retrieved articles on the ABPA in the databases at home and abroad published in the recent 10 years, there were 22 foreign reports and only one case in domestic report. Among the 22 foreign cases, 16 patients were CF, 3 were asthmatics. ABPA was diagnosed as the initial presentation in only one case with CF.

CONCLUSIONIn asthmatics or the patients with allergic disease, if there are highly elevated serum total IgE, central bronchiectasis or recurrent atelectasis in chest imaging, the patients should be further investigated for ABPA. The diagnosed cases of ABPA should be screened for CF routinely.

Antifungal Agents ; Aspergillosis, Allergic Bronchopulmonary ; diagnosis ; therapy ; Aspergillus fumigatus ; Asthma ; Bronchiectasis ; Child ; Cough ; Cystic Fibrosis ; Humans ; Pulmonary Atelectasis ; Retrospective Studies ; Thorax ; Tomography, X-Ray Computed ; Voriconazole

PURPOSE: To correlate radiologic findings with clinical findings in patients with a mosaic patten of lungattenuation, as seen on thin-section CT. MATERIALS AND METHODS: Thirty-one cases in which a mosaic pattern oflung attenuation was detected on combined expiratory and inspiratory scans of thin-section CT were retrospectivelyanalyzed. Cases involving infiltrative lung disease were excluded. Both thin-section CT and clinical findings wereanalyzed and the relationship between the extent of the area of hyperlucency -as seen on expiratory scan- andphysiologic parameters was evaluated. The subjects were 10 men and 21 women ranged in age from 25 to 76 (mean 50)years. RESULT: Twenty-nine patients with small airway disease, [chronic bronchitis and/or bronchiolitis(n=11),bronchiectasis(n=8), bronchial asthma(n=8), mycoplasmic pneumonitis(n=1) and hypersensitive pneumonitis(n=1),] andtwo patients with pulmonary vascular disease, [chronic pulmonary thromboembolism(n=1) and stenosis of the leftupper pulmonary artery(n=1)] were included in our study. Commonly associated thin-section CT findings in the casesinvolving small airway disease(n=29) were bronchial wall thickening(n=25), nodular opacity(n=25), bronchial andbronchiolar dilatation(n=20) and small branching opacity(n=16). These findings were not observed in two patientswith pulmonary vascular disease, though bronchial wall thickening was seen in the patient with chronic pulmonarythromboembolism. At expiratory scan level, there was statistical correlation between FEV1/FVC and the number ofpulmonary segments(r= 0.982, p<0.05), but no correlation between FEV1/FVC and the percentage area ofhyperlucency(r=0.803, p>0.05). CONCLUSION: The mosaic pattern of lung attenuation seen on thin-section CT isindicative of various diseases, involving small airways such as bronchiolitis, bronchitis, bronchiectasis andbronchial asthma, and vascular lung disease. Bronchial wall thickening and nodular opacity can be associated withsmall airway diseases.
Asthma ; Bronchiectasis ; Bronchiolitis ; Bronchitis ; Constriction, Pathologic ; Female ; Humans ; Lung Diseases ; Lung* ; Male ; Vascular Diseases

Aspergillosis is a systemic fungal infection caused by Aspergilli, mainly, Aspergillus fumigatus. The pulmonary aspergillosis is a group of three separate disease, comprising invasive aspergillosis, aspergilloma, and allergic bronchopulmonary aspergillosis (ABPA), or a disease process in which one of three entities overlap with another process. ABPA is a chracterized clinically by asthma, blood and sputum eosinophilia and recurrent pulmonary infiltrations or mucoid impaction, which pathogenesis seems to be hypersensitivity reaction to Aspergillus fumigatus (Af). Recently we experienced a case of ABPA, one of three clinical manifestations of pulmonary aspergillosis. He had asthma as an infant, but had no asthmatic symptoms on admission, and there was no evidence of fungal infection at blood culture and routine bacterial culture with sputum. But, diagnosis was confirmed by test for immediate skin reaction to Af was positive, skin prick test and Greenburg and Petterson's criteria. After steroid treatment, he became asymptomatic. We report this case with brief review of literature.
Aspergillosis ; Aspergillosis, Allergic Bronchopulmonary* ; Aspergillus fumigatus ; Asthma ; Diagnosis ; Eosinophilia ; Humans ; Hypersensitivity ; Infant ; Pulmonary Aspergillosis ; Skin ; Sputum

The fungus aspergillus can cause a variety of pulmonary disorders. Aspergilloma is a noninvasive aspergillus colonization of virtually any type of preexisting pulmonary cavity or Cystic space. Invasive pulmonary aspergillosis is serious, usually fatal infection in patients being treated with immunosuppressants or who have chronic debilitating disease. Allergic bronchopulmonary aspergillosis is charaterized clinically by asthma, blood and sputum eosinophilia and positive immunologic reaction to aspergillus antigen. Awareness of the radio-graphic and CT findings of pulmonary aspergillosis is important in making the diagnosis of aspergillus-caused pulmonary disorders. In this pictorial essay, we illustrated various radiological findings of pulmonary aspergillosis focused on CT findings correlated with gross pathologic specimens.
Aspergillosis, Allergic Bronchopulmonary ; Aspergillus ; Asthma ; Colon ; Diagnosis ; Eosinophilia ; Fungi ; Humans ; Immunosuppressive Agents ; Invasive Pulmonary Aspergillosis ; Pulmonary Aspergillosis* ; Sputum

The fungus aspergillus can cause a variety of pulmonary disorders. Aspergilloma is a noninvasive aspergillus colonization of virtually any type of preexisting pulmonary cavity or Cystic space. Invasive pulmonary aspergillosis is serious, usually fatal infection in patients being treated with immunosuppressants or who have chronic debilitating disease. Allergic bronchopulmonary aspergillosis is charaterized clinically by asthma, blood and sputum eosinophilia and positive immunologic reaction to aspergillus antigen. Awareness of the radio-graphic and CT findings of pulmonary aspergillosis is important in making the diagnosis of aspergillus-caused pulmonary disorders. In this pictorial essay, we illustrated various radiological findings of pulmonary aspergillosis focused on CT findings correlated with gross pathologic specimens.
Aspergillosis, Allergic Bronchopulmonary ; Aspergillus ; Asthma ; Colon ; Diagnosis ; Eosinophilia ; Fungi ; Humans ; Immunosuppressive Agents ; Invasive Pulmonary Aspergillosis ; Pulmonary Aspergillosis* ; Sputum