Kroegel C, Haidl P, Kohlhäufl M, Voshaar T
Medizinische Klinik I, Abt. Pneumologie & Allergologie, Friedrich-Schiller-Universität Jena.
Pneumologie. 2012 Jan;66(1):28-38. doi: 10.1055/s-0031-1291530. Epub 2012 Jan 16.
The term "bronchiolitis" refers to a broad spectrum of common conditions related to the small airways associated with a miscellaneous aetiology, histology, clinical features and course. Due to their variability, bronchiolar disorders are generally difficult to diagnose. History (smoking, collagen vascular disease, inhalational injury, medication usage, and organ transplant) may point towards a bronchiolar process. In addition, signs of systemic and pulmonary infection and evidence of air trapping may provide diagnostic hints. Although clinical presentation, physical examination, pulmonary function tests (obstructive ventilatory defect), and plain chest radiographs may demonstrate abnormalities suggesting small airways involvement, they are often non-specific and rarely diagnostic. In contrast, the high-resolution CT (HR-CT) scanning of the chest provides three distinct HR-CT patterns that assist in the diagnosis and differential diagnosis of bronchiolar conditions: (i) a tree-in-bud pattern, (ii) ill-defined centrilobular ground-glass nodules, and (iii) a mosaic attenuation pattern (best visible on expiratory images). The present paper summarises the current knowledge, the classification, imaging, and the clinical presentation of bronchiolar disorders.
“细支气管炎”一词指的是一系列与小气道相关的常见病症,其病因、组织学、临床特征和病程各不相同。由于其变异性,细支气管疾病通常难以诊断。病史(吸烟、胶原血管病、吸入性损伤、药物使用和器官移植)可能提示存在细支气管病变。此外,全身和肺部感染的体征以及气体潴留的证据可能提供诊断线索。尽管临床表现、体格检查、肺功能测试(阻塞性通气缺陷)和平片胸部X线检查可能显示提示小气道受累的异常,但这些往往是非特异性的,很少能确诊。相比之下,胸部高分辨率CT(HR-CT)扫描提供了三种不同的HR-CT模式,有助于细支气管疾病的诊断和鉴别诊断:(i)树芽征,(ii)边界不清的小叶中心磨玻璃结节,以及(iii)马赛克衰减模式(在呼气图像上最明显)。本文总结了细支气管疾病的现有知识、分类、影像学表现和临床表现。