Dilated Bronchioles Research Articles

Stiffness reduction and collagenase resistance of aging lungs measured using scanning acoustic microscopy.

Lung tissue stiffness is altered with aging. Quantitatively evaluating lung function is difficult using a light microscope (LM) alone. Scanning acoustic microscope (SAM) calculates the speed-of-sound (SOS) using sections to obtain histological images by plotting SOS values on the screen. As SOS is positively correlated with stiffness, SAM has a superior characteristic of simultaneously evaluating tissue stiffness and structure. SOS images of healthy bronchioles, arterioles, and alveoli were compared among young, middle-aged, and old lung sections. Formalin-fixed, paraffin-embedded (FFPE) sections consistently exhibited relatively higher SOS values than fresh-frozen sections, indicating that FFPE became stiffer but retained the relative stiffness reflecting fresh samples. All lung components exhibited gradually declining SOS values with aging and were associated with structural alterations such as loss of smooth muscles, collagen, and elastic fibers. Moreover, reaction to collagenase digestion resulted in decreased SOS values. SOS values of all components were significantly reduced in young and middle-aged groups, whereas no significant reduction was observed in the old group. Protease damage in the absence of regeneration or loss of elastic components was present in old lungs, which exbited dilated bronchioles and alveoli. Aging lungs gradually lose stiffness with decreasing structural components without exposure to specific insults such as inflammation.

Recurrent Respiratory Tract Infection in a 24-Year-Old Female Secondary to a Foreign Body Aspiration

Foreign body aspiration (FBA) is a common problem necessitating prompt recognition and early treatment to minimize the potentially severe and sometimes fatal consequences. We presented a 24-year-old girl who was admitted for chronic cough and recurrent pneumonia associated with constitutional symptoms. She was feverish with a temperature of 39°C and had tachycardia and tachypnoea with an oxygen saturation of 98%. Investigations revealed leukocytosis. CXR showed right lower lobe consolidation, and CT thorax demonstrated collapse consolidation of the right middle and lower lobe, along with associated dilated segmental bronchioles and diffuse patch ground-glass opacity in both lung fields. Bronchoscopy revealed a pen cap at the entrance of the right lower lobe. Patient symptoms improved after removal of the foreign body. In patients with recurrent chest infection, the physician should check for the possibility of FBA and prompt for a referral to a tertiary center for further evaluation.

Ameliorative effects of Panax ginseng on lung of Lambada cyhalotherin-intoxicated rats

Introduction: Lambada-cyhalotherin (LCT) caused severe oxidative damage in liver, lung and testis.Aim of the Study: The objective of this research was to evaluate the ameliorative activity and underlying techniques of pure Panax ginseng (G) using rat model of LCT-induced lung damage.Materials and Methods: 36 male adult laboratory rats Rattus norvegicus domestica in weights around 135±10 g were separated into 6 experimental groups: 1st control group. 2nd and 3th groups were G groups (100 and 200 mg G/kg b. wt.) LCT group was given by oral gavage LCT (61.2 mg /kg b. wt.) that is equivalent to 1/10 of LD50. The 5th and 6th groups were co-treated with two doses of G.Results: LCT significantly decreased superoxide dismutase (SOD), catalase (CAT) and total thiol (T. thiol) and increased lipid peroxidation (LPO). mRNA and protein expression levels of p53 gene (apoptotic gene) were increased, whereas, Bcl-2 gene (anti-apoptotic gene) mRNA and protein expression levels were decreased in LCT-treated animals. Also, light microscopic and ultrastructure studies for lung tissues of LCT-treated animals showed marked hyperplasia of dilated bronchioles wall, RBCs extravasation in bronchiolium lumen and mononuclear leukocytic infiltration in parenchyma. Additionally, blood vessels congested with thickened walls, alveoli appeared collapsed with compensatory expansion of adjacent alveoli divided by thickened inter-alveolar septa, besides to damage in type 1 and type 2 pneumocytes. G co-treatment attenuated oxidative stress biomarkers. Both tested doses of G significantly decreased p53 and elevate Bcl-2 mRNA and protein expression levels and revealed significant amelioration and restoration of normal histology and ultrastructure of lung.Conclusion: In summary, G has exhibited ameliorative activity against oxidative stress induced by LCT in lung, apoptosis, histopathological and ultrastructural changes in albino rats.

Aberrant Epithelial Cell Proliferation in Peripheral Airways in Bronchiectasis.

Dilation of bronchi and bronchioles caused by destruction and excessive epithelial remodeling is a characteristic feature of bronchiectasis. It is not known how epithelial progenitor cells contribute to these pathologic conditions in peripheral airways (bronchioles) in bronchiectasis. We aimed to explore the expression levels of signature airway progenitor cells in the dilated bronchioles in patients with bronchiectasis. We obtained the surgically resected peripheral lung tissues from 43 patients with bronchiectasis and 33 control subjects. Immunostaining was performed to determine the expression patterns of thyroid transcription factor-1 (TTF-1, for labeling progenitor cells in distal airways), P63 (basal cells), club cell 10 kDa protein (CC10, club cells), and surfactant protein C (SPC, alveolar type II epithelial cells) in epithelium or sub-epithelium. Here, we reported significantly lower percentage of TTF-1+ cells and CC10+ cells, and higher percentage of P63+ cells within the epithelium of dilated bronchioles compared with control bronchioles. In airway sub-epithelium of the dilated bronchioles, epithelial hyperplasia with disarrangement of TTF-1+ cells yielded cuboidal (100%) and columnar (93.0%) type among bronchiectasis patients. Most progenitor cell markers co-localized with TTF-1. The median (the 1st, 3rd quartile) percentage of P63+TTF-1+, CC10+TTF-1+, and SPC+TTF-1+ cells was 16.0% (8.9, 24.0%), 14.5% (7.1, 20.8%), and 52% (40.3, 64.4%), respectively. For cuboidal epithelial hyperplasia, 91.0% (86.5, 94.0%) of areas co-stained with SPC and TTF-1. Columnar epithelial hyperplasia was characterized by TTF-1 co-staining with P63+TTF-1+ and CC10+TTF-1+ cells. Taken together, aberrant proliferation of airway progenitor cells in both epithelium and sub-epithelium are implicated in bronchiectasis.

VATS LOBECTOMY FOR BRONCHIAL ATRESIA IN AN ADULT

SESSION TITLE: Surgery cases SESSION TYPE: Fellow Case Reports PRESENTED ON: 10/07/2018 04:45 PM - 05:45 PM INTRODUCTION: Bronchial atresia is a rare congenital anomaly caused by an atretic or interrupted lobar or segmental bronchus that results in a mucous filled bronchus and distal hyperinflation of the obstructed lung. Such malformations are generally diagnosed at an early age; however, it is diagnosed in adults as well. Due to its rarity, it is quite frequently misdiagnosed as the symptoms are commonly attributed to pulmonary infection. Surgical intervention is curative and minimally invasive options are safe and feasible. The goal of this case report is to highlight the clinical presentation, work-up and treatment of bronchial atresia in the adult. CASE PRESENTATION: A 28 year-old man presented with recurrent respiratory infections and right sided chest pain for the past decade. CXR showed a hyperlucent RLL (Fig 1). A CT scan of the chest demonstrated central RLL bronchi that were markedly dilated, branching and filled with mucous, with a “finger-in-glove” configuration, with distal hyperinflation and paucity of vascular markings. A central obstructing lesion was absent (Fig 2a and b). The patient had a perfusion scan showing that the RLL has decreased perfusion. Initially, the patient was taken to the operating room for a flexible bronchoscopy with biopsy and bronchiolar lavage. However, there was no evidence of any obstructing lesions on bronchoscopy. The patient was then later discussed at multidisciplinary lung conference. We decided to proceed to flexible bronchoscopy and video-assisted thoracoscopic right lower lobectomy. The post-operative course of the patient was uneventful and he discharged on POD 6. Pathology showed markedly dilated bronchioles that were impacted with viscous, tan-gray mucin (Fig 3). He has not had bouts of pneumonia since the removal of the right lower lobe. DISCUSSION: Bronchial atresia is usually asymptomatic and many cases are diagnosed in the second or third decades in life. Symptoms are usually consistent with recurrent pulmonary infections. Diagnosis can be made from a CT scan of the chest showing the pathognomonic findings of bronchial obstruction, hyper-lucency and hyperinflation of the distal airways with mucous impaction. However, due to its rarity, we suggest initial diagnostic bronchoscopy to rule out obstruction. If obstruction is ruled out, in symptomatic patients, surgical intervention should absolutely be taken and is curative. In asymptomatic patients, treatment is controversial. Follow-up is necessary to evaluate progression. Elective lobectomy or segmentectomy should be carefully considered in these patients. Overall, preferably, a minimally invasive approach should be taken. CONCLUSIONS: In patients with bronchial atresia, pulmonary infection and obstruction should be excluded before resection. Resection in an asymptomatic patient is still controversial and should be carefully considered. Minimally invasive approaches are preferable. Reference #1: Wang, Y., W. Dai, et al. (2012). "Congenital bronchial atresia: diagnosis and treatment." Int J Med Sci 9(3): 207-212. Reference #2: Traibi, A., A. Seguin-Givelet, et al. (2017). "Congenital bronchial atresia in adults: thoracoscopic resection." J Vis Surg 3(174). DISCLOSURES: No relevant relationships by Patrick Chan, source=Web Response No relevant relationships by Ernest Chan, source=Web Response No relevant relationships by Rajeev Dhupar, source=Web Response no disclosure on file for Matthew Schuchert; no disclosure on file for Anupama Sharma; No relevant relationships by Diane Strollo, source=Web Response

Extralobar sequestration of lung associated with congenital diaphragmatic hernia and malrotation of gut.

Extralobar sequestration of lung is a rare congenital malformation frequently diagnosed during repair of congenital diaphragmatic hernia. However, the combined association of congenital diaphragmatic hernia with both pulmonary sequestration and malrotation of gut is rare. We report a case of a 1-year-old girl with extralobar sequestration of lung and malrotation of gut detected during the repair of diaphragmatic hernia. The histopathological examination of the sequestered lobe revealed dilated bronchioles, alveolar ducts and alveoli along with dilated subpleural and peribronchiolar lymphatics and areas of type II congenital pulmonary airway malformation.

Pleural solitary fibrous tumor with bullae: is it a microinvasive tumor?

We report a rare pleural solitary fibrous tumor with bullae. Chest computed tomography showed a nodular lesion with bullae adjacent to the left diaphragm. Thoracoscopic resection followed by a pathology study showed that the tumor was a solitary fibrous tumor beside the visceral pleura. We suggest that the bullae containing dilated bronchioles were caused by a check-valve mechanism next to the microinvasive component in the solitary fibrous tumor.

Clinical/Pathologic Correlations in 553 Patients With Primary Centrilobular Findings on High-Resolution CT Scan of the Thorax

Clinical/pathologic correlations in patients with high-resolution CT (HRCT) scan findings presenting with two patterns of centrilobular opacity remain unclear. Chest HRCT scans in 553 patients with predominant centrilobular opacities or preferential centrilobular disease were retrospectively evaluated. In 141 patients who underwent biopsy, CT scan images were compared with actual specimens. Centrilobular nodules with a tree-in-bud appearance and bronchial wall thickening were observed in most patients who were carriers of human T-lymphotropic virus type 1 (88 patients and 57 of 99 patients, respectively), Mycoplasma pneumoniae pneumonia (44 patients and 45 of 52 patients, respectively), Mycobacterium tuberculosis (38 patients and 37 of 52 patients, respectively), Mycobacterium avium-intracellulare complex (22 patients and 27 of 37 patients, respectively), Mycobacterium kansasii (27 patients and 19 of 33 patients, respectively), allergic bronchopulmonary aspergillosis (6 patients and 7 of 9 patients, respectively), diffuse panbronchiolitis (12 patients and 10 of 12 patients, respectively), and diffuse aspiration bronchiolitis (12 patients and 12 of 13 patients, respectively). On the other hand, ill-defined centrilobular nodules of ground-glass attenuation were frequently seen in patients with subacute hypersensitivity pneumonitis (all 15 patients), metastatic calcification (all 4 patients), Churg-Strauss syndrome (4 of 12 patients), microscopic polyangiitis (27 of 48 patients), systemic lupus erythematosus (7 of 8 patients), and respiratory bronchiolitis-associated interstitial lung disease (all 8 patients). Pathologically, the tree-in-bud appearance correlated well with the plugging of small airways with mucous, pus, or fluid; dilated bronchioles; and bronchiolar wall thickening. Ill-defined centrilobular nodules represented peribronchiolar inflammation or the deposition of hemorrhagic materials. Knowledge of the two centrilobular patterns is of proven worth for generating differential diagnoses and is of particular value in suggesting a likely infectious etiology in cases with tree-in-bud appearance.

Non-small cell lung cancer coexisting with pulmonary aspergilloma

A 77-year-old male with a long-standing history of smoking and working in mines was referred to our department for the evaluation of an enlarging subpleural mass in the right upper lobe. Both transbronchial and computed tomography-guided biopsies of the mass were non-diagnostic. A partial resection of the right S2 mass under video-assisted thoracic surgery (VATS) confirmed the diagnosis of primary non-small cell lung cancer. VATS right upper lobectomy (ND2a) was then performed for complete resection. Histological examination revealed that the mass composed of adenocarcinoma and the dilated bronchioles contained Aspergillus, the fungal component. Here we report a rare case of non-small cell lung cancer coexisting with pulmonary aspergillosis. The morphologic coexistence pattern of the two pathologies was believed to be the colonization of saprophytic Aspergillus in the bullous air spaces, obstructed by or contained within the tumor, according to the progression of the lung cancer.

Respiratory change in size of honeycombing: inspiratory and expiratory spiral volumetric CT analysis of 97 cases.

The purpose of this study was twofold: to evaluate the change in size of honeycomb cysts with respiration using inspiratory-expiratory spiral volumetric CT (I-E SVCT) and to establish the pathologic basis of this change. Ninety-seven patients, who had honeycombing associated with end-stage pulmonary fibrosis on end-inspiratory 1 to 2 mm collimation high-resolution CT (HRCT), underwent I-E SVCT (3 mm collimation, pitch 1, breath-hold time 20 s, reconstruction interval 1 mm, FOV 16-20 cm, high frequency algorithm). I-E SVCT scans were assessed on images obtained in the transverse plane and volumetric sagittal, coronal, and oblique reformations. The histologic findings were assessed in four inflated and fixed lungs that showed honeycombing at postmortem HRCT. In 63 patients (65%), a small percentage of the cysts did not change in size at end-expiration, while in the remaining patients, all the cysts decreased in size. Assessment of volumetric multiplanar reformations showed that cysts that decreased in size during exhalation communicated with airways and represented bronchiolectasis rather than true cysts, while the other cysts did not communicate with the airways. Similar findings were found in pathologic specimens. The majority of, but not all, honeycomb cysts seen on HRCT represent dilated bronchioles that communicate with the proximal airways and change in size with respiration.

Usual interstitial pneumonia: histologic correlation with high-resolution CT.

The authors reviewed 46 cases of idiopathic pulmonary fibrosis with usual interstitial pneumonia (UIP), correlating findings on high-resolution computed tomographic (HRCT) scans with findings in specimens obtained at open lung biopsy and autopsy. The following HRCT findings were observed: (a) an accumulation of small cystic spaces with thick walls, (b) air bronchiolograms within areas of intense lung attenuation, (c) rugged pleural surfaces, (d) irregularly thickened pulmonary vessels, (e) bronchial wall thickening, and (f) slightly increased lung attenuation. Macroscopic honeycombing correlating with small cystic spaces was demonstrated at HRCT and pathologic examination. Air bronchiolograms in the areas of intense lung attenuation (ie, microscopic honeycombing) corresponded to dilated bronchioles (greater than 1 mm in diameter) with fibrosis. Irregularly thickened vessels and bronchial walls and irregular pleural surfaces were the result of fibrosis in the periphery of the secondary pulmonary lobules. Areas of slightly increased lung attenuation seen on the HRCT scans correlated with patchy alveolar septal fibrosis or inflammation. The authors conclude that microscopic honeycombing and a perilobular distribution in UIP may be clearly identified with HRCT.

Pulmonary Elastic Fibers in Normal Human Development and in Pathological Conditions

Normal human pulmonary elastic fiber development and development in some pathological conditions were examined using elastic stains by light microscopy, electron microscopy, and immunohistochemistry. In normal development elastic fibers, composed mainly of microfibrils, first appeared around primitive bronchioles at 10 weeks of gestation. As they matured, their appearance became more amorphous, and they extended into the peripheral alveolar walls. Development of elastic fibers was retarded in the hypoplastic lungs of the oligohydramnios syndrome, diaphragmatic hernia, and hydrops fetalis. Elastic development was also retarded in congenital pulmonary lymphangiectasia and in focal areas of lungs with pulmonary dysplasia. Distribution of well-developed elastic fibers was found around the dilated bronchioles and alveoli in cases of congenital cystic adenomatoid malformation and extralobar pulmonary sequestration. Elastic fibers were distributed irregularly and unevenly in the lungs of bronchopulmonary dysplasia and ventilated cases of Wilson Mikity syndrome. In addition, four very immature infants who had progressively deteriorating respiratory function showed an almost total lack of elastic fibers in their alveolar walls.

A congenital adenomatoid malformation of the lungs in a calf.

A 7-month-old fetal calf had a diffuse, solid adenomatoid malformation of the left diaphragmatic lobe of the lungs. The malformation consisted of a large white mass with a lobular pattern. The lobules had a sponge-like structure without any cysts and contained dilated bronchioles, lined by a single layer of epithelial cells and a layer of elastic fibres. There were neither cartilaginous rings nor muscle fibres. The anomaly was associated with generalized fetal hydrops, oedema of the fetal membranes, and indications of hydramnion or hydrallantois.