CTICasesBronchiolitis Obliterans (Constrictive Bronchiolitis) with Tracheobronchomalacia
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Imaging findings
High-resolution CT (HRCT) images showed striking mosaic attenuation within the lungs, which on expiratory images clearly represented air trapping. Within these areas of air trapping, the associated bronchi exhibited thickening and, at times, slight dilation. Dynamic expiratory CT demonstrated severe collapse of the trachea, measuring just above 70% reduction in cross-sectional area, which meets the updated diagnostic criterion for tracheobronchomalacia.
Key takeaways
Mosaic attenuation with air trapping and associated bronchial wall thickening/dilation on HRCT is classic for bronchiolitis obliterans (constrictive bronchiolitis). The differential diagnosis for bronchiolitis obliterans includes adenovirus, inhalation injury, rheumatoid arthritis (the most common connective tissue disease cause), lung or stem cell transplant, and medications (mnemonic: AIRTRx). The updated diagnostic cutoff for tracheobronchomalacia on dynamic expiratory CT is greater than 70% reduction in tracheal cross-sectional area. It is important not to over-read isolated collapse of the bronchus intermedius, which can be a normal finding.
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