Chest
Chest Imaging and Pathology for Clinicians: Special FeatureBronchiolar Disorders: A Clinical-Radiological Diagnostic Algorithm
Section snippets
HRCT Scan—Anatomic Correlations: Imaging the Secondary Pulmonary Lobule
Bronchioles are small airways < 2 mm in diameter without cartilage or submucosal glands. This includes terminal bronchioles, whose principal role is to conduct air to the respiratory bronchioles.6 The latter contain alveoli, which are the site of air conduction and gas exchange. Critical to the HRCT scan identification of bronchiolar diseases is detailed familiarity with the cross-sectional appearance of secondary pulmonary lobules. As defined by Miller,7 the secondary pulmonary lobule
Stepwise Approach to Bronchiolar Disorders
The clinical presentation of patients with bronchiolar disorders depends on the cause and varies from insidious onset of cough and shortness of breath to an acute, fulminant illness. A proposed algorithmic approach that takes into consideration the history, physical findings, pulmonary function tests, and imaging studies is outlined in Figure 6.
Conclusions
Bronchiolitis is a nonspecific inflammation of the respiratory bronchioles and peribronchiolar alveolar sacs that has variable causes, clinical manifestations, and evolution. However, suggestive, specific diagnoses are rarely made based on clinical history alone. As both CXR and PFT findings are also frequently nonspecific, a high index of clinical suspicion should be maintained in order to diagnose and/or exclude bronchiolar disease. Given these limitations, in our experience, HRCT scanning
Acknowledgments
Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Other contributions: We thank Ms. Patrice Balistreri for her invaluable secretarial assistance and coordination.
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