The “tree-in-bud-pattern” of images on thin-section lung CT is defined by centrilobular branching structures that resemble a budding tree. We investigated the pathological basis of the tree-in-bud lesion by reviewing the pathological specimens of bronchograms of normal lungs and contract radiographs of the post-mortem lungs manifesting active pulmonary tuberculosis. The tree portion corresponds to the intralobular inflammatory bronchiole, while the bud portion represents filling of inflammatory substances within alveolar ducts, which are larger than the corresponding bronchioles. Inflammatory bronchiole per se represents the “tree” (stem) and inflammatory alveolar ducts constitute the “buds” or clubbing. “Clusters of micronodules”, seen on 7-mm thick post-mortem radiographs with tuberculosis proved to be clusters of tree-in-bud lesions within the three-dimensional space of secondary pulmonary lobule based on radiological/pathological correlation. None of the post-mortem lung specimens showed findings of lung parenchymal lymphatics involvement.
Bronchioles ; Lung ; Trees ; Tuberculosis ; Tuberculosis, Pulmonary*

Respiratory bronchiolitis-associated interstitial lung disease has been described among current or former smokers and has features consistent with interstitial lung disease. Symptoms include cough, dyspnea on exertion. Lung pathology is characterized by the accumulation of pigmented macrophages within respiratory bronchioles and adjacent air spaces associated with mild thickening of the peribronchiolar interstitium. It must be separated from the other interstitial lung disease because of marked differences in treatment and prognosis. Recently we experienced a case of respiratory bronchiolitis -associated interstitial lung disease in a 48-year-old man. As far as we know, this is the first case in Korea.
Bronchioles ; Bronchiolitis ; Cough ; Dyspnea ; Humans ; Korea ; Lung ; Lung Diseases, Interstitial* ; Macrophages ; Middle Aged ; Pathology ; Prognosis ; Smoking

Cryptogenic organizing pneumonia (COP) is an inflammatory lung disease involving the distal bronchioles, respiratory bronchioles, bronchiolar ducts, and alveolae. The etiology is usually unknown; however, there are several known causes and associated systemic diseases. Corticosteroid therapy is the best treatment option and the prognosis of COP is good, with recovery in up to 80% of patients. We described a patient with in-operable hepatocellular carcinoma (HCC) undergoing chemoembolization with doxorubicin in a drug-eluting bead (DEB). COP developed in the patient after chemoembolization but resolved spontaneously in several months.
Bronchioles ; Carcinoma, Hepatocellular* ; Chemoembolization, Therapeutic ; Cryptogenic Organizing Pneumonia* ; Doxorubicin ; Humans ; Lung Diseases ; Prognosis

Pulmonary alveolar proteinosis is a rare disorder that is characterized by the abundant accumulation of surfactant-derived material within the alveolar spaces and distal bronchioles. Although the findings of homogenous ground-glass opacities overlaid by thickened septa, which form a "crazy paving" pattern on high-resolution computed tomography, can assist in making a diagnosis, a lung biopsy is usually required. This disorder has a variable clinical course, from spontaneous resolution to respiratory failure and death. While a whole lung lavage has been the standard treatment since the early 1960s, GM-CSF therapy has been attempted based on the recently suggested pathogenetic mechanism. We report a case of pulmonary alveolar proteinosis that resolved spontaneously after an open lung biopsy.
Biopsy ; Bronchioles ; Bronchoalveolar Lavage ; Diagnosis ; Granulocyte-Macrophage Colony-Stimulating Factor ; Lung ; Pulmonary Alveolar Proteinosis* ; Respiratory Insufficiency

Diffuse panbronchiolitis(DPB) is a chronic inflammatory airway disease predominantly affecting respiratory bronchioles, with distinct clinicopathological profiles. It was first described in 1966 by Yamanaka et al. The etiology of DPB is not yet clear, and the natural history of the disease is respiratory failure leading to cor pulmonale and ultimately death. But the long-term use of low-dose macrolide has proven to be highly effective in treating patients with DPB. Usual age at diagnosis is over 40. A few cases of DPB have been reported in Korea since 1992 but there have been no reports in children. We experienced a case of DPB in a 12-year-old girl. Therefore, we report the case with a brief review of the related literature.
Bronchioles ; Child ; Diagnosis ; Female ; Humans ; Korea ; Natural History ; Pulmonary Heart Disease ; Respiratory Insufficiency

Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) is an inflammatory lung disorder associated with cigarette smoking. The clinical and radiographic findings of RB-ILD are nonspecific and most patients with RB-ILD are thought to have some form of idiopathic pulmonary fibrosis prior to lung biopsy. Open lung biopsy of patients with RB-ILD reveals inflammation of the respiratory bronchioles, filling of the bronchiolar lumens and surrounding alveoli with finely pigmented macrophages, associated interstitial inflammation. Alveolar septa, particularly around terminal and membranous bronchioles, are mildly fibrotic. We recently experienced a case of RB-ILD proven by open lung biopsy.
Biopsy ; Bronchioles ; Humans ; Idiopathic Pulmonary Fibrosis ; Inflammation ; Lung ; Lung Diseases, Interstitial* ; Macrophages ; Smoking

Pulmonary alveolar proteinosis(PAP) is a disorder in which an insoluble, proteinaceous material, rich in phospholipid, is deposited on alveoli and bronchioles. Several cases were reported since 1986, and the numbers of patients is increasing in Korea. Although the pathogenesis and causative treatment of PAP is not well known, whole lung lavage is the only consistently successful treatment. We report 2 cases of PAP which were confirmed by open lung biopsy with electron microscopy and clinically improved by whole lung lavage with a review of literature.
Biopsy ; Bronchioles ; Bronchoalveolar Lavage* ; Humans ; Korea ; Lung* ; Microscopy, Electron ; Pulmonary Alveolar Proteinosis*

Bronchiolitis obliterans (BO) is a non-specific inflammatory injury that affects the small airways, resulting in progressive dyspnea and airflow limitation. The inflammatory process is characterized by granulation tissue filling the lumen of the terminal and respiratory bronchioles, extending into the distal air spaces. BO is usually described in association with bone marrow, heart-lung, or lung transplantation. Outside transplantation, it is rare. We report a 66-year-old female patient who presented with dyspnea that resulted in a diagnosis of BO with bronchiectasis.
Aged ; Bone Marrow ; Bronchiectasis ; Bronchioles ; Bronchiolitis ; Bronchiolitis Obliterans ; Dyspnea ; Female ; Granulation Tissue ; Humans ; Lung Transplantation ; Transplants

PURPOSE: Diffuse panbronchiolitis(DPB) is a chronic inflammatory airway disease of unknown causes mainly affecting the respiratory bronchioles and the more proximal bronchi. Findings on chest radiographs and high-resolution CT(HRCT) are well known and Akira classified HRCT findings of DPB into four types. Purpose of this study is to evaluate the relationship between findings of HRCT and PFT. METHODS AND MATERIALS: We retrospectively analyzed the chest radiographs and HRCT images of eleven patients with DPB and compared CT classification with pulmonary function test. RESULTS: Chest radiographs usually showed small nodular opacities throughout the both middle and lower lungs. The HRCT findings of DPB were centrilobularly distributed small nodular densities, branching linear densities contiguous with small round densities, dilated and thickened peripheral and central airways including bronchioles. More than one CT type by Akira's classification, usually two or three types, were found in nine patients. There was good correlation between CT types and FEV1%(p<0.05), CT types and FEV1/FVC (p<0.05) respectively. CONCLUSION: HRCT seems to be more useful for diagnosis and disease progression of DPB as compared with the chest radiographs or clinical stage such as pulmonary function test.
Bronchi ; Bronchioles ; Classification ; Diagnosis ; Disease Progression ; Humans ; Lung ; Radiography, Thoracic ; Respiratory Function Tests* ; Retrospective Studies

Sarcoidosis is a rare systemic disorder with unknown cause that is characterized pathologically by non-caseating granuloma. The lung and mediastinal lymph nodes are almost always involved, and most patients experience acute or insidious respiratory symptom. Because sarcoidosis is an interstitial lung disorder involving the alveoli and bronchioles, the most common radiological finding is a reticularnodular lesion with lymphatic distribution. However, cavitation is quite rare. Sarcoidosis is also a major cause of hepatic granuloma in Western countries, accounting for 12% to 30% of cases. In most patients, the course of hepatic sarcoidosis is benign. However, chronic intrahepatic cholestasis or portal hypertension may develop in some patients. We report a case of sarcoidosis with cavitation and hepatic involvement.
Bronchioles ; Cholestasis, Intrahepatic ; Granuloma ; Humans ; Hypertension, Portal ; Lung ; Lymph Nodes ; Sarcoidosis*