Case 62

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Clinical History:
The patient was a 4 year old male who was diagnosed with reactive airways disease at 1 month of age. Since then, he had been hospitalized 3 times due to reactive airways disease. Family history was remarkable for 2 sisters with reactive airways disease. His wheezing was worse when awake and was not responsive to steroids or nebulizers. He now presented with respiratory distress and fever.

Clinical Physical Exam:
Febrile, in respiratory distress.

Clinical Labs:
RSV and parainfluenza titers, IgE titers, a Ph probe for gastroesophageal reflux and a sweat test were negative. Pulmonary function tests showed an obstructive picture.

Clinical Differential Diagnosis:
Bronchiolitis obliterans with organizing pneumonia

Imaging Findings:
A barium swallow was unremarkable (not provided). A V/Q scan showed mild hyperinflation of the lungs, but was otherwise negative (not provided). A chest film showed hyperinflation. A chest CT exam showed scattered ground glass opacities.

Images 1 and 2

Images 3 and 4

Images 5 and 6

Imaging Differential Diagnosis:
Bronchiolitis obliterans with organizing pneumonia

Operative Findings:
Bronchoscopy was negative for airway foreign body or tracheomalacia. An open lung biopsy of the lingula was performed.

Pathological Findings:
Pathological examination of the surgical specimen revealed bronchiolitis without fibrosis or obliteration and airway stasis. There were no fungus, bacteria, or viruses seen.

Final Diagnosis:
Bronchiolitis Obliterans

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course.

Similar Cases:
Case 11, Case 63

References:

• International Thoracic Teaching Resource - http://www.vh.org/adult/provider/radiology/ITTR/BronchObliterans/BronchObliterans.html

Title Page

URL: http://www.virtualpediatrichospital.org/