CTICasesWood-Burning Stove Smoke Inhalation Lung Injury
Imaging findings
CT demonstrates diffuse peribronchial thickening, air trapping with geographic areas of low attenuation on inspiratory images, and well-defined tree-in-bud nodularity throughout the lungs. Follow-up CT several years later shows progression with more extensive air trapping, persistent peribronchial thickening, and continued tree-in-bud opacities. The pattern has features of both bronchiolitis obliterans organizing pneumonia and small airway disease with the well-defined solid branching tree-in-bud nodularity.
Key takeaways
Chronic exposure to wood-burning stove smoke can cause a bronchiolitis obliterans organizing pneumonia-like pattern on CT, characterized by tree-in-bud nodularity, air trapping, and peribronchial thickening. This exposure-related injury may mimic other causes of tree-in-bud nodularity but the history of significant wood-smoke inhalation in the domestic setting over many decades should raise this consideration. Well-defined solid tree-in-bud nodularity in this context may represent bronchiolitis obliterans.
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