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Presented by Ralph Hruban, M.D. and prepared by Maryam Farinola M.D.
Case 3: This patient developed shotness of breadth several years after a lung transplant.
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Question 1 of 1
1. Question
Week 198: Case 3
This patient developed shotness of breadth several years after a lung transplant./images/OB 1.jpg
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/images/OB 4.jpgCorrect
Answer: Obliterative bronchiolitis
Histology: The small airways (bronchioles) in this transbronchial lung biopsy are remarkable for a diffuse and circumferential luminal narrowing. The subepithelial connective tissue layer is dramatically thicked, to the point where the lumen is barely perceptible.
Discussion: Obliterative bronchiolitis is a dreaded long-term complication of lung transplantation. Obliterative bronchiolitis is characterized by a diffuse and circumferential expansion of the sub-epithelial connective tissue. Over time it can progress to the point that the patient requires a re-transplant. Because it has such a poor prognosis, obliterative bronchiolitis needs to be distinguished from other processes such as bronchiolitis obliterans organizing pneumonia (BOOP) which can be seen following a lung infection or other insult to the lung. The fibroblastic proliferation in BOOP extends out intot he alveolar spaces, while in obliterative bronchiolitis it is limited to the bronchioles.
Reference(s):
– Corris, et al. Lung transplantation. Bronchiolitis obliterans syndrome. Chest Surg Clin N Am. 2003 Aug;13(3):543-57.
– Estenne, et al. J Heart Lung Transplant. 2002 Mar;21(3):297-310.Incorrect
Answer: Obliterative bronchiolitis
Histology: The small airways (bronchioles) in this transbronchial lung biopsy are remarkable for a diffuse and circumferential luminal narrowing. The subepithelial connective tissue layer is dramatically thicked, to the point where the lumen is barely perceptible.
Discussion: Obliterative bronchiolitis is a dreaded long-term complication of lung transplantation. Obliterative bronchiolitis is characterized by a diffuse and circumferential expansion of the sub-epithelial connective tissue. Over time it can progress to the point that the patient requires a re-transplant. Because it has such a poor prognosis, obliterative bronchiolitis needs to be distinguished from other processes such as bronchiolitis obliterans organizing pneumonia (BOOP) which can be seen following a lung infection or other insult to the lung. The fibroblastic proliferation in BOOP extends out intot he alveolar spaces, while in obliterative bronchiolitis it is limited to the bronchioles.
Reference(s):
– Corris, et al. Lung transplantation. Bronchiolitis obliterans syndrome. Chest Surg Clin N Am. 2003 Aug;13(3):543-57.
– Estenne, et al. J Heart Lung Transplant. 2002 Mar;21(3):297-310.
