CTICasesRespiratory Bronchiolitis in an Active Smoker
Imaging findings
High-resolution chest CT demonstrates beautifully defined, ground-glass centrilobular nodules distributed predominantly throughout the upper and middle lung zones, with relative sparing of the lung bases. The nodules correspond to individual acinar units in a highly regular, lobular distribution, with no evidence of significant septal thickening or fibrosis.
Key takeaways
Respiratory bronchiolitis (RB) is a common, often asymptomatic histological and imaging pattern in active cigarette smokers. On HRCT, it manifests as poorly defined centrilobular ground-glass nodules that represent the accumulation of pigmented macrophages within the peribronchiolar alveolar spaces. While the appearance can overlap with subacute hypersensitivity pneumonitis (HP), RB typically has an upper lung predominance and occurs almost exclusively in active smokers.
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