Weinman Jason P, Manning David A, Liptzin Deborah R, Krausert Amanda J, Browne Lorna P
Department of Radiology, Children's Hospital Colorado, 13123 E. 16th Ave., Box 125, Aurora, CO, 80045, USA.
Department of Radiology, Children's Hospital of New Orleans, New Orleans, LA, USA.
Pediatr Radiol. 2017 Dec;47(13):1759-1765. doi: 10.1007/s00247-017-3951-5. Epub 2017 Aug 26.
Follicular bronchiolitis is a lymphoproliferative form of interstitial lung disease (ILD) defined by the presence of peribronchial lymphoid follicles. Follicular bronchiolitis has been associated with viral infection, autoimmune disease and immunodeficiency. The most common clinical manifestation is respiratory distress in infancy followed by a prolonged course with gradual improvement. We found no reports of systematic review of high-resolution computed tomography (HRCT) findings in pediatric follicular bronchiolitis.
The purpose of this study was to describe the HRCT findings of follicular bronchiolitis in children and correlate these imaging findings with histopathology.
A 5-year retrospective review of all pathology-proven cases of follicular bronchiolitis was performed. Inclusion criteria were age <18 years and an HRCT within 6 months of lung biopsy. HRCTs were reviewed by three observers and scored using the system previously described by Brody et al.
Six patients met the inclusion criteria with age range at HRCT of 7-82 months (median: 39.5 months). Pulmonary nodules (n=6) were the most common HRCT finding followed by focal consolidation (n=5), bronchiectasis (n=4) and lymphadenopathy (n=3). Tree and bud opacities and nodules on CT correlated with interstitial lymphocytic infiltrates and discrete lymphoid follicles on pathology.
The salient HRCT findings of childhood follicular bronchiolitis are bilateral, lower lung zone predominant pulmonary nodules and bronchiectasis with infantile onset of symptoms. These characteristic HRCT findings help differentiate follicular bronchiolitis from other forms of infantile onset ILD.
滤泡性细支气管炎是间质性肺疾病（ILD）的一种淋巴增殖性形式，其定义为存在支气管周围淋巴滤泡。滤泡性细支气管炎与病毒感染、自身免疫性疾病和免疫缺陷有关。最常见的临床表现是婴儿期的呼吸窘迫，随后病程延长并逐渐改善。我们未发现有关儿童滤泡性细支气管炎高分辨率计算机断层扫描（HRCT）结果的系统评价报告。
本研究的目的是描述儿童滤泡性细支气管炎的HRCT表现，并将这些影像学表现与组织病理学相关联。
对所有经病理证实的滤泡性细支气管炎病例进行了为期5年的回顾性研究。纳入标准为年龄<18岁且在肺活检后6个月内进行HRCT检查。由三名观察者对HRCT进行评估，并使用Brody等人先前描述的系统进行评分。
6例患者符合纳入标准，HRCT检查时年龄范围为7 - 82个月（中位数：39.5个月）。肺结节（n = 6）是最常见的HRCT表现，其次是局灶性实变（n = 5）、支气管扩张（n = 4）和淋巴结病（n = 3）。CT上的树芽征和结节与病理上的间质淋巴细胞浸润和离散淋巴滤泡相关。
儿童滤泡性细支气管炎的显著HRCT表现为双侧、以肺下区为主的肺结节和支气管扩张，症状始于婴儿期。这些特征性的HRCT表现有助于将滤泡性细支气管炎与其他形式的婴儿期起病的ILD区分开来。
