CTICasesInhalation-Induced Bronchiolitis
Imaging findings
Chest CT shows diffuse, symmetric centrilobular ground-glass nodules and tree-in-bud opacities, with a slight upper lobe predominance and sparing of the pleural surfaces and fissures. There is no cardiomegaly or pulmonary arterial enlargement. On follow-up, the tree-in-bud pattern mostly resolves, leaving faint centrilobular ground-glass nodules typical of respiratory bronchiolitis.
Key takeaways
Acute inhalation injury from smoking contaminated or synthetic marijuana (such as 'spice' or chemical-adulterated joints) can cause a severe, diffuse inflammatory bronchiolitis. This presents on CT as tree-in-bud and centrilobular ground-glass nodules, which can mimic infectious bronchiolitis or hypersensitivity pneumonitis, but characteristically shows rapid improvement upon cessation of exposure.
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