Bronchiolitis Obliterans

Aka: Bronchiolitis Obliterans

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II. Pathophysiology

  1. Obstruction of Bronchioles by granulation tissue
  2. Triggered by injury to Bronchiolar epithelium
    1. Response to Bronchiolar reinjury during repair phase
    2. Results in excessive granulation tissue proliferation

III. Causes

  1. Inhalation of toxic fumes
  2. Exposure to mineral dust
  3. Transplantation
    1. Bone Marrow Transplant with graft-versus-host disease
    2. Heart-Lung Transplantation
  4. Hypersensitivity pneumonitis
  5. Medications: Penicillamine
  6. Infection
    1. Mycoplasma pneumoniae
    2. Legionella
    3. Viral respiratory infections
  7. Rheumatologic Conditions
    1. Rheumatoid Arthritis
    2. Systemic Lupus Erythematosus
    3. Dermatomyositis
    4. Polymyositis

IV. Symptoms

  1. Non-productive cough with Dyspnea
  2. Onset 2-8 weeks after respiratory injury (see causes)

V. Signs

  1. Expiratory Wheezes

VI. Imaging: Chest XRay

  1. Variable pattern (may be normal)
  2. Diffuse nodular pattern
  3. Distal hyperinflation

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