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Presented by Ralph Hruban, M.D. and prepared by Zarir E. Karanjawala, M.D., Ph.D.
Case 2: This 50-some year old male presented with increasing shortness of breath.
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Question 1 of 1
1. Question
Week 314: Case 2
This 50-some year old male presented with increasing shortness of breath. A wedge biopsy of the lung was performed.images/hruban0618072A.jpg
images/hruban0618072b.jpgCorrect
Answer: Constrictive bronchiolitis
Histology: The biopsy shows unremarkable lung parenchyma except for the bronchioles. They are narrowed by a concentric fibrosis.
Discussion: Constrictive bronchiolitis obliterans is characterized by a concentric fibrosis that narrows the lumens of the bronchioles. It can often be hard to recognize because the absence of something (lumens in the bronchioles) is harder to recognize than the presence of something that should not be there. There are a variety of causes of constrictive bronchiolitis including drug reaction, collagen vascular diseases, viral infection, and lung transplantation. Obliterative bronchiolitis in lung transplant recipients is a manifestation of chronic rejection. Clinically these patients present with shortness of breadth and cough and on pulmonary function test they are found to have obstructive changes. Chest X-rays often reveal overinflation of the lung. Unfortunately, the prognosis for these patients is poor.
Incorrect
Answer: Constrictive bronchiolitis
Histology: The biopsy shows unremarkable lung parenchyma except for the bronchioles. They are narrowed by a concentric fibrosis.
Discussion: Constrictive bronchiolitis obliterans is characterized by a concentric fibrosis that narrows the lumens of the bronchioles. It can often be hard to recognize because the absence of something (lumens in the bronchioles) is harder to recognize than the presence of something that should not be there. There are a variety of causes of constrictive bronchiolitis including drug reaction, collagen vascular diseases, viral infection, and lung transplantation. Obliterative bronchiolitis in lung transplant recipients is a manifestation of chronic rejection. Clinically these patients present with shortness of breadth and cough and on pulmonary function test they are found to have obstructive changes. Chest X-rays often reveal overinflation of the lung. Unfortunately, the prognosis for these patients is poor.
