Radiology
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Abstract Freely available
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Howling, S. J.
Right arrow Articles by Müller, N. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Howling, S. J.
Right arrow Articles by Müller, N. L.
(Radiology. 1999;212:637-642.)
© RSNA, 1999

Thoracic Imaging

Follicular Bronchiolitis: Thin-Section CT and Histologic Findings1

Sarah J. Howling, MB, David M. Hansell, MD, Athol U. Wells, MB, Andrew G. Nicholson, DM, Julia D. A. Flint, MD and Nestor L. Müller, MD, PhD

1 From the Departments of Radiology (S.J.H., N.L.M.) and Pathology (J.D.A.F.), Vancouver Hospital and Health Sciences Centre, University of British Columbia, 855 W 12th Ave, Vancouver, BC, Canada V5Z 1M9; the Departments of Radiology (D.M.H.) and Pathology (A.G.N.), Royal Brompton National Heart and Lung Hospital, London, England; and the Department of Respiratory Medicine, Green Lane Hospital, Auckland, New Zealand (A.U.W.). Received September 10, 1998; revision requested November 2; revision received December 14; accepted March 26, 1999. Address reprint requests to N.L.M.


   Abstract
TOP
 Abstract
Introduction
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 References
 
PURPOSE: To evaluate the thin-section computed tomographic (CT) findings of follicular bronchiolitis and compare them with the histologic findings.

MATERIALS AND METHODS: Thin-section CT scans obtained in 12 patients (age range, 24–77 years; mean age, 47 years) with follicular bronchiolitis proved at open lung biopsy were reviewed by two observers. Underlying conditions included rheumatoid arthritis (n = 8), mixed collagen vascular disorders (n = 2), autoimmune disorder (n = 1), and acquired immunodeficiency syndrome (n = 1). All patients had thin-section CT scans (1.0–1.5-mm collimation, 11 patients; 3.0-mm collimation, one patient; high-spatial-frequency reconstruction algorithm) obtained at 10-mm intervals through the chest.

RESULTS: The main CT findings included bilateral centrilobular (n = 12) and peribronchial (n = 5) nodules. All 12 patients had nodules smaller than 3 mm in diameter; six patients also had nodules 3–12 mm in diameter. Areas of ground-glass opacity were present in nine (75%) patients. Histologically, all patients had lymphoid hyperplasia along the bronchioles; eight had peribronchiolar lymphocytic infiltration.

CONCLUSION: The cardinal CT feature of follicular bronchiolitis consists of small centrilobular nodules variably associated with peribronchial nodules and areas of ground-glass opacity.

Index terms: Bronchiolitis, 60.2191 • Lung, CT, 60.12118 • Lung, nodule, 60.281 • Lymphatic system, hyperplasia, 996.826 • Pneumonitis, lymphocytic interstitial, 60.213


   Introduction
TOP
 Abstract
 Introduction
MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 References
 
Follicular bronchiolitis, defined as lymphoid hyperplasia of the bronchus-associated lymphoid tissue, is characterized histologically by the presence of hyperplastic lymphoid follicles with reactive germinal centers distributed along the bronchioles and, to a lesser extent, bronchi (1–3). Most cases are associated with collagen vascular diseases, immunodeficiency, or hypersensitivity reaction (2–5).

It has been postulated that follicular bronchiolitis accounts for the poorly defined centrilobular and subpleural nodules seen at computed tomography (CT) in 20%–70% of patients with collagen vascular disease (6,7). Limited information is available, however, about the correlation between the CT and histologic findings in follicular bronchiolitis (4,6,7). The aim of the present study was to review the CT findings in 12 patients with biopsy-proved follicular bronchiolitis and to compare the CT with the histologic findings.


   MATERIALS AND METHODS
TOP
 Abstract
 Introduction
 MATERIALS AND METHODS
RESULTS
 DISCUSSION
 References
 
The thin-section CT scans obtained in 12 patients (five men, seven women; age range, 24–77 years; mean age, 47 years) with biopsy-proved follicular bronchiolitis were studied retrospectively. The study group included eight patients with rheumatoid arthritis, two with mixed collagen vascular diseases, one with a nonspecific autoimmune disorder, and another with acquired immunodeficiency syndrome. Two patients were current smokers, two were ex-smokers, and eight had never smoked. The 12 patients were all those with a diagnosis of follicular bronchiolitis who underwent CT at the authors' institutions between July 1987 and July 1997. Patients who had a histologic diagnosis of follicular bronchiolitis but did not have CT scans available for review were excluded from the study. A histologic diagnosis of follicular bronchiolitis characterized by prominent hyperplasia of lymphoid follicles around the airways was required for inclusion (1,3).

The study included only patients in whom follicular bronchiolitis was the predominant or the only abnormality seen histologically. Patients with lymphoid hyperplasia related to bronchiectasis or chronic pulmonary infection or in association with pulmonary neoplasms were excluded from the study.

CT scans were obtained with an electron-beam scanner (Imatron, San Francisco, Calif; n = 8), a model 9800 or Prospeed Sx Advantage scanner (GE Medical Systems, Milwaukee, Wis; n = 3), or a Somotom DR scanner (Siemens, Iselin, NJ; n = 1). Thin-collimation (1.0–1.5-mm- collimation, 11 patients; 3.0-mm-collimation, one patient) sections were obtained at 10-mm intervals from the lung apices to the bases, with the patient breath holding in full inspiration. Images were reconstructed by using a high-spatial-frequency algorithm and were printed with window settings appropriate for viewing the lungs (window width, 1,000–1,500 HU; window level, -700 to -600 HU). CT scans were interpreted simultaneously by two radiologists (S.J.H., N.L.M.), and conclusions were reached by consensus.

The CT scans were assessed for the presence and distribution of ground-glass opacity, airspace consolidation, nodules, and peribronchial and interlobular septal thickening. The presence and extent of associated findings such as bronchial dilatation, emphysema, architectural distortion, honeycombing, mosaic perfusion, and pleural effusion were also assessed. "Ground-glass opacity" was defined as a hazy increase in lung opacity in which the bronchi and vessels remained visible, and "airspace consolidation" was defined as an area of increased attenuation with obscuration of bronchovascular structures. Bronchial dilatation was considered present when the internal diameter of a bronchus was greater than that of the adjacent pulmonary artery or when a bronchus was visualized within 1 cm of the costal pleura. The diagnosis of bronchial wall thickening was based on subjective assessment.

Parenchymal nodules were categorized according to size: smaller than 3 mm, between 3 and 10 mm, and larger than 10 mm. Distribution of parenchymal nodules was recorded as (a) centrilobular when nodules were identified around peripheral pulmonary arterial branches or 3–5 mm away from the pleura, interlobular septa, or pulmonary veins; (b) peribronchial when nodules were identified around lobar, segmental, or subsegmental bronchi; (c) subpleural if there was a predilection for the outer third of the lung in the transverse plane; and (d) indeterminate. The distribution of nodules was also assessed as being within areas of ground-glass opacity or away from areas of ground-glass opacity and as being greater in areas with ground-glass opacity or greater away from areas of ground-glass opacity. To determine the distribution of parenchymal abnormalities, each lung was divided into three zones: upper, or superior to the level of the tracheal carina; middle, or between the level of the carina and the level of the inferior pulmonary veins; and lower, or below the level of the inferior pulmonary veins. Each zone was evaluated separately.

Chest CT was performed within 15 days of histologic diagnosis in 11 patients and within 31 days in one patient (median, 8 days). In all patients, the diagnosis was proved at open lung biopsy. Lung biopsy specimens were obtained from at least two lobes at surgery in seven patients and from one lobe in five.

Statistical analysis was performed by using the Fisher exact test and the matched-pairs signed rank test.


   RESULTS
TOP
 Abstract
 Introduction
 MATERIALS AND METHODS
 RESULTS
DISCUSSION
 References
 
CT Findings
The most common CT abnormalities consisted of parenchymal nodular opacities and areas of ground-glass opacity (Table).


View this table:
[in this window]
[in a new window]
  		Main CT and Histopathologic Findings
 
Nodules were present in all 12 patients (Fig 1). They were bilateral in all patients and were diffuse (n = 8), involved mainly the lower zones (n = 3), or were equally distributed in the upper and lower zones (n = 1). Nodules less than 3 mm in diameter were observed in all 12 patients, with nodules between 3 and 10 mm in diameter identified in five (42%) patients (Fig 2). Nodules greater than 10 mm in diameter were seen in only one patient. A centrilobular distribution was observed in all 12 patients, with additional peribronchial nodules also present in five (42%) and subpleural nodules in three (25%) patients (Fig 2). There was no appreciable difference in the size, distribution, or profusion of nodules between patients with rheumatoid arthritis and patients with other collagen vascular diseases (Table).



View larger version (86K):
[in this window]
[in a new window]
  		Figure 1. Follicular bronchiolitis. Thin-section (1.5-mm-collimation) CT scan through the lower zones in a 61-year-old man with a mixed collagen vascular disease demonstrates multiple well-defined nodules. Several nodules (solid arrows) are clustered and a few millimeters from the pleura or interlobular septa, which indicates centrilobular distribution. Mild interlobular septal thickening (open arrows) is also present.

 


View larger version (145K):
[in this window]
[in a new window]
  		Figure 2. Follicular bronchiolitis. Thin-section (1.5-mm-collimation) CT scan in a 24-year-old woman with rheumatoid arthritis demonstrates nodules (arrows) in a peribronchovascular distribution. The nodules measure between 3 and 10 mm in diameter.

 
The second most common finding, observed in nine (75%) of 12 patients, was the presence of areas of ground-glass opacity (Fig 3). In all but one patient, the areas of ground-glass opacity were bilateral and had a nonsegmental, patchy distribution.



View larger version (124K):
[in this window]
[in a new window]
  		Figure 3. Follicular bronchiolitis. Thin-section (1-mm-collimation) CT scan in a 77-year-old man with an autoimmune disorder shows small centrilobular (arrows) and peribronchial nodules, peribronchial thickening, and small patchy areas of ground-glass opacity.

 
The nodular profusion in areas of ground-glass opacity was compared with the nodular profusion in the remainder of the lung parenchyma. In seven of eight patients with a patchy ground-glass pattern, nodules were most profuse in the areas of ground-glass opacity (P = .01, matched-pairs signed rank test).

Less common CT findings included bronchial dilatation (n = 4), bronchial wall thickening (n = 4), emphysema (n = 4), architectural distortion (n = 3), mild interlobular septal thickening (n = 2), and peribronchovascular consolidation (n = 1). Mosaic perfusion was not seen in any of the patients. There were no pleural effusions or areas of honeycombing.

Histologic Findings
The histologic findings consisted of hyperplastic lymphoid follicles with reactive germinal centers distributed along the bronchioles and, to a lesser extent, bronchi (Fig 4). Eight (67%) patients also had a mild degree of lymphocytic interstitial infiltration, often more marked around the airways but also present to a lesser extent in the adjacent alveolar walls (Fig 5). Two patients showed slightly more extensive interstitial infiltration histologically (Fig 6). The infiltrate consisted of small lymphocytes, plasma cells, and histiocytes. Interstitial infiltrates were identified histologically in eight of the nine patients who had areas of ground-glass opacity at CT but not in the three patients who did not have areas of ground-glass opacity (P < .005, Fisher exact test).



View larger version (119K):
[in this window]
[in a new window]
  		Figure 4a. Follicular bronchiolitis in a 24-year-old woman with rheumatoid arthritis. (a) Histologic specimen shows mild hyperplasia of a lymphoid follicle (arrow). (Hematoxylin-eosin stain; original magnification, x20.) (b) High-power view shows a benign hyperplastic germinal center. (Hematoxylin-eosin stain; original magnification, x100.)

 


View larger version (172K):
[in this window]
[in a new window]
  		Figure 4b. Follicular bronchiolitis in a 24-year-old woman with rheumatoid arthritis. (a) Histologic specimen shows mild hyperplasia of a lymphoid follicle (arrow). (Hematoxylin-eosin stain; original magnification, x20.) (b) High-power view shows a benign hyperplastic germinal center. (Hematoxylin-eosin stain; original magnification, x100.)

 


View larger version (131K):
[in this window]
[in a new window]
  		Figure 5a. Follicular bronchiolitis. (a) Histologic specimen in a 36-year-old woman with rheumatoid arthritis shows that abundant lymphoid follicles are distributed along the bronchiole (br). This causes compression of the bronchiolar lumen, which contains an inflammatory exudate. There is only minimal peribronchiolar lymphocytic interstitial infiltration. (Hematoxylin-eosin stain; original magnification, x20.) (b) Histologic specimen in a 49-year-old man with acquired immunodeficiency syndrome demonstrates marked lymphoid hyperplasia that expands the peribronchiolar tissue and encroaches on the bronchiolar wall (br). Also noted is infiltration into the adjacent alveolar walls (arrows). (Hematoxylin-eosin stain; original magnification, x20.)

 


View larger version (146K):
[in this window]
[in a new window]
  		Figure 5b. Follicular bronchiolitis. (a) Histologic specimen in a 36-year-old woman with rheumatoid arthritis shows that abundant lymphoid follicles are distributed along the bronchiole (br). This causes compression of the bronchiolar lumen, which contains an inflammatory exudate. There is only minimal peribronchiolar lymphocytic interstitial infiltration. (Hematoxylin-eosin stain; original magnification, x20.) (b) Histologic specimen in a 49-year-old man with acquired immunodeficiency syndrome demonstrates marked lymphoid hyperplasia that expands the peribronchiolar tissue and encroaches on the bronchiolar wall (br). Also noted is infiltration into the adjacent alveolar walls (arrows). (Hematoxylin-eosin stain; original magnification, x20.)

 


View larger version (161K):
[in this window]
[in a new window]
  		Figure 6. Follicular bronchiolitis in a 28-year-old woman with rheumatoid arthritis. Histologic specimen shows reactive peribronchial germinal center (straight solid arrow) and infiltration of the adjacent parenchyma by mononuclear cells, predominantly lymphocytes. A second focal collection of lymphocytes (curved arrow) obliterates the adjacent airway. The accompanying pulmonary artery (open arrow) can be seen.

 

   DISCUSSION
TOP
 Abstract
 Introduction
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
References
 
In 1973, Bienenstock et al (8) detailed the normal anatomic distribution of lymphoid tissue in the lung as being along the bronchial tree and interlobular septa and within subpleural nodes. When stimulation of the bronchus-associated lymphoid tissue results in a polyclonal hyperplasia of lymphoid follicles around the bronchioles, the term "follicular bronchiolitis" is used (1,2). Such reactive lymphoid follicles are situated between bronchioles and pulmonary arteries and frequently compress the bronchiolar lumen. Lymphoid hyperplasia of the lungs is a common phenomenon that frequently accompanies chronic infections and is often seen around tumors or abscesses (1,2). However, lymphoid hyperplasia in the absence of tumors or chronic inflammation is uncommon; the largest series we know of was reported by Yousem et al (2) and included only 19 cases.

There have been several recent studies describing the thin-section CT appearances in bronchial and bronchiolar diseases, but there has been little emphasis on the CT findings of follicular bronchiolitis (4,5,9). Remy-Jardin et al (6,7) reviewed the thin-section CT findings in patients with rheumatoid arthritis or progressive systemic sclerosis and found airway abnormalities in 23 (27%) of 84 patients with rheumatoid arthritis. Nodules less than 3 mm in diameter were identified in 17% of 84 patients with rheumatoid arthritis and 46% of 56 patients with systemic sclerosis. The authors suggested that these parenchymal micronodules presumably represented foci of follicular bronchiolitis, a frequent histologic feature in both conditions. Ground-glass opacities (in 54% of patients) and subpleural micronodules (in 85% of patients) were also observed in systemic sclerosis. The authors suggested that the subpleural micronodules might represent small lymphoid aggregates adjacent to the pleura (7).

In the present study, nodules were the most common finding at CT; they were observed in all 12 patients. Ranging in size from 1 to 12 mm, they were located predominantly in a centrilobular distribution, although additional peribronchial nodules were present in five (42%) patients. This CT pattern of nodular attenuation is not surprising considering that the predominant histologic findings were of peribronchiolar inflammation and coalescent germinal centers, which are frequently associated with an acute inflammatory exudate within the compressed bronchiolar lumen.

Bronchial dilatation is commonly seen in patients with bronchiolitis (10,11). It is, therefore, possible that the bronchiectasis seen in four patients in the current study was a secondary manifestation of the follicular bronchiolitis. Amorosa et al (12) also described the presence of bronchiectasis in children with lymphocytic interstitial pneumonia. They postulated that the bronchiectasis in lymphocytic interstitial pneumonia may be secondary to compression of the bronchiolar lumen by peribronchiolar infiltration, which may lead to atelectasis and bronchiectasis. The presence of interlobular septal thickening in two patients is difficult to explain on the basis of the histologic findings of follicular bronchiolitis and may have represented incidental, unrelated abnormalities.

The main differential diagnosis of follicular bronchiolitis is with lymphocytic interstitial pneumonia (1,13,14). Lymphocytic interstitial pneumonia shows several histologic features that are similar to those seen in follicular bronchiolitis and is also seen with increased frequency in patients with autoimmune disorders, particularly Sjögren syndrome and immunodeficiency states (13,15,16). The two conditions can be distinguished histologically by virtue of the extent of infiltration and expansion of the interstitium, which is predominantly peribronchial and peribronchiolar in follicular bronchiolitis but diffuse in lymphocytic interstitial pneumonia (1,13,14). Nevertheless, there may be considerable overlap between follicular bronchiolitis and lymphocytic interstitial pneumonia, which compose a spectrum of lymphoid hyperplasia within the lung, and the decision to allocate a specific diagnosis often rests on which component the pathologist believes to be dominant. Thus, although lymphocytic interstitial pneumonia and follicular bronchiolitis are part of the same spectrum of disease, a diagnosis of follicular bronchiolitis can be made when the mononuclear cell infiltration has a predominantly peribronchial and peribronchiolar distribution. This distribution and the focal nature of the infiltrates presumably account for the centrilobular and peribronchial distribution of nodules seen on CT.

Limited information is available about the CT findings in patients with lymphocytic interstitial pneumonia (17–21). The most common CT abnormality found in immunocompetent patients is bilateral areas of ground-glass opacity, which are infrequently associated with small nodules or cysts (17–19,21). In those adult patients with immunodeficiency states, small (2–4-mm) nodules are the predominant CT finding (20). Therefore it is reasonable to postulate that there is considerable overlap between the thin-section CT findings of lymphocytic interstitial pneumonia and those of follicular bronchiolitis.

A centrilobular distribution of abnormalities is by no means specific to follicular bronchiolitis and has been reported in a variety of diseases that predominantly affect the centrilobular bronchioles, pulmonary arteries, and lymphatic vessels (22). In the absence of a tree-in-bud sign, centrilobular nodules are most typical of bronchiolar diseases not associated with infection, including cystic fibrosis, bronchiectasis, panbronchiolitis, sarcoidosis, respiratory bronchiolitis, and extrinsic allergic alveolitis (23–25).

In three of our 12 patients, one of whom had rheumatoid arthritis, histologic examination also revealed a few airways with fibrous obliteration. Similar mixed findings have been reported in previous studies (4,26), and Wells and du Bois (27) speculated that follicular bronchiolitis and obliterative bronchiolitis might coexist. The exact relationship, if any, however, between these two lesions remains unclear. Furthermore, both conditions occur in isolation in rheumatoid arthritis, and thus an apparent relationship might be coincidental.

Our study has several limitations, including a relatively small number of patients, its retrospective nature, and a lack of direct correlation between the CT and the histologic findings. In particular, because the CT scans and histologic specimens were not obtained on the same day, it is conceivable that the areas of ground-glass opacity seen at CT may have been due to pulmonary edema or pneumonia. Furthermore, there may have been improvement or worsening of the interstitial lymphocytic infiltration in the interval between CT and lung biopsy.

In summary, we reviewed the CT scans of 12 patients who had biopsy-proved follicular bronchiolitis. The cardinal signs of follicular bronchiolitis were a mixed pattern of small centrilobular nodules variably associated with patchy ground-glass opacity. Additional peribronchial nodules were a frequent finding.


   Footnotes
 
Author contributions: Guarantors of integrity of entire study, S.J.H., N.L.M.; study concepts and design, D.M.H., N.L.M.; definition of intellectual content, S.J.H., A.U.W., N.L.M.; literature research, S.J.H., A.U.W., N.L.M.; clinical studies, D.M.H., A.U.W., A.G.N., J.D.A.F., N.L.M.; data acquisition, S.J.H., D.M.H., A.U.W., N.L.M.; data analysis, S.J.H., N.L.M.; statistical analysis, A.U.W.; manuscript preparation, S.J.H., N.L.M.; manuscript editing, S.J.H., D.M.H., A.U.W., N.L.M.; manuscript review, S.J.H., D.M.H., A.U.W., A.G.N., N.L.M.


   References
TOP
 Abstract
 Introduction
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 References
 

  1. Myers JL, Kurtin PJ. Lymphoid proliferative disorders of the lung. In: Thurlbeck WM, Churg AM, eds. Pathology of the lung. 2nd ed. New York, NY: Thieme, 1995; 535-588.
  2. Yousem SA, Colby TV, Carrington CB. Follicular bronchitis/bronchiolitis. Hum Pathol 1985; 16:700-706.[Medline]
  3. Fortoul TI, Cano-Valle F, Oliva E, Barrios R. Follicular bronchiolitis in association with connective tissue diseases. Lung 1985; 163:305-314.[Medline]
  4. Hayakawa H, Sato A, Imokawa S, Toyoshima M, Chida K, Iwata M. Bronchiolar disease in rheumatoid arthritis. Am J Respir Crit Care Med 1996; 154:1531-1536.[Abstract]
  5. Kinoshita M, Higashi T, Tanaka C, Tokunaga N, Ichikawa Y, Oizumi K. Follicular bronchiolitis associated with rheumatoid arthritis. Intern Med 1992; 31:674-677.[Medline]
  6. Remy-Jardin M, Remy J, Cortet B, Mauri F, Declambre B. Lung changes in rheumatoid arthritis: CT findings. Radiology 1994; 193:375-382.[Abstract/Free Full Text]
  7. Remy-Jardin M, Remy J, Wallaert B, Bataille D, Hatron P. Pulmonary involvement in progressive systemic sclerosis: sequential evaluation with CT, pulmonary function tests, and bronchoalveolar lavage. Radiology 1993; 188:499-506.[Abstract/Free Full Text]
  8. Bienenstock J, Johnston N, Perey DYE. Bronchial lymphoid tissue. I. Morphologic characteristics. Lab Invest 1973; 28:686-692.[Medline]
  9. Reittner P, Fotter R, Lindbichler F, et al. HRCT features in a 5-year-old child with follicular bronchiolitis. Pediatr Radiol 1997; 27:877-879.[Medline]
  10. Lentz D, Bergin CJ, Berry GJ, Stoehr C, Theodore J. Diagnosis of bronchiolitis obliterans in heart-lung transplantation patients: importance of bronchial dilatation on CT. AJR 1992; 159:463-467.[Abstract/Free Full Text]
  11. Müller NL, Miller RR. Diseases of the bronchioles: CT and histopathologic findings. Radiology 1995; 196:3-12.[Free Full Text]
  12. Amorosa JK, Miller RW, Laraya-Cuasay L, et al. Bronchiectasis in children with lymphocytic interstitial pneumonia and acquired immune deficiency syndrome: plain film and CT observations. Pediatr Radiol 1992; 22:603-607.[Medline]
  13. Kradin RL, Mark EJ. Benign lymphoid disorders of the lung, with a theory regarding their development. Hum Pathol 1983; 14:857-867.[Medline]
  14. Nicholson AG, Wotherspoon AC, Diss TC, et al. Reactive pulmonary lymphoid disorders. Histopathology 1995; 26:405-412.[Medline]
  15. Strimlan CV, Rosenow EC, Divertie MB, et al. Pulmonary manifestations of Sjogren's syndrome. Chest 1976; 70:354-361.
  16. White DN, Mattay RA. Non-infectious pulmonary complications of infection with the human immunodeficiency virus. Am Rev Respir Dis 1989; 140:1763-1787.[Medline]
  17. Fraser RG, Pare JAP, Pare PD, Fraser RS, Genereux GP. Diagnosis of diseases of the chest 3rd ed. Philadelphia, Pa: Saunders, 1988; 1568-1573.
  18. Ishikawa Y, Kinoshita M, Koga T, Oizumi K, Fujimoto K, Hayabuchi N. Lung cyst formation in lymphocytic interstitial pneumonia: CT features. J Comput Assist Tomogr 1994; 18:745-748.[Medline]
  19. Berdon WE, Mellins RB, Abramson SJ, Ruzal-Shapiro C. Pediatric HIV infection in its second decade: the changing pattern of lung involvement—clinical, plain film, and computed tomographic findings. Radiol Clin North Am 1993; 31:453-464.[Medline]
  20. McGuinness G, Scholes JV, Jagirdar JS, et al. Unusual lymphoproliferative disorders in nine patients with HIV or AIDS: CT and pathologic findings. Radiology 1995; 197:59-65.[Abstract/Free Full Text]
  21. Desai SR, Nicholson AG, Stewart S, Twentyman OM, Flower DR, Hansell DM. Benign pulmonary lymphocytic infiltration and amyloidosis: computed tomographic and pathologic features in three cases. J Thorac Imaging 1997; 12:215-220.[Medline]
  22. Gruden JF, Webb WR, Warnock M. Centrilobular opacities in the lung on high-resolution CT: diagnostic considerations and pathologic correlation. AJR 1994; 162:569-574.[Abstract/Free Full Text]
  23. Murata K, Itoh H, Todo G, et al. Centrilobular lesions of the lung: demonstration by high-resolution CT and pathologic correlation. Radiology 1986; 161:641-645.[Abstract/Free Full Text]
  24. Murata K, Khan A, Herman PG. Pulmonary parenchymal disease: evaluation with high-resolution CT. Radiology 1989; 172:467-471.[Abstract/Free Full Text]
  25. Gurney JW. Cross-section physiology of the lung. Radiology 1991; 178:1-10.[Abstract/Free Full Text]
  26. Epler GR, Snider GL, Gaensler EA, Cathcart ES, Fitzgerald MX, Carrington CB. Bronchiolitis and bronchitis in connective tissue disease: a possible relationship to the use of penicillamine. JAMA 1979; 242:528-532.[Abstract]
  27. Wells AU, du Bois RM. Bronchiolitis in association with connective tissue disorders. Clin Chest Med 1993; 14:655-666.[Medline]



This article has been cited by other articles:


Home page
 ChestHome page
F. Okada, Y. Ando, S. Yoshitake, A. Ono, S. Tanoue, S. Matsumoto, M. Wakisaka, T. Maeda, and H. Mori
Clinical/Pathologic Correlations in 553 Patients With Primary Centrilobular Findings on High-Resolution CT Scan of the Thorax
Chest, December 1, 2007; 132(6): 1939 - 1948.
[Abstract] [Full Text] [PDF]

Home page
 RadioGraphicsHome page
C. Mueller-Mang, C. Grosse, K. Schmid, L. Stiebellehner, and A. A. Bankier
What Every Radiologist Should Know about Idiopathic Interstitial Pneumonias
RadioGraphics, May 1, 2007; 27(3): 595 - 615.
[Abstract] [Full Text] [PDF]

Home page
 ImagingHome page
T Stone, J H Reynolds, and H J Williams
Imaging of large and small airway diseases
Imaging, September 1, 2006; 18(3): 139 - 150.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
W. R. Webb
Thin-Section CT of the Secondary Pulmonary Lobule: Anatomy and the Image--The 2004 Fleischner Lecture
Radiology, May 1, 2006; 239(2): 322 - 338.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
M. R. Aerni, R. Vassallo, and J. H. Ryu
SUCCESSFUL TEATMENT OF FOLLICULAR BRONCHIOLITIS WITH MACROLIDE
Chest Meeting Abstracts, October 1, 2005; 128(4): 428S - 428S.
[Abstract] [PDF]

Home page
 Am. J. Roentgenol.Home page
S. J. Pipavath, D. A. Lynch, C. Cool, K. K. Brown, and J. D. Newell
Radiologic and Pathologic Features of Bronchiolitis
Am. J. Roentgenol., August 1, 2005; 185(2): 354 - 363.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
N. Tanaka, J. S. Kim, J. D. Newell, K. K. Brown, C. D. Cool, R. Meehan, T. Emoto, T. Matsumoto, and D. A. Lynch
Rheumatoid Arthritis-related Lung Diseases: CT Findings
Radiology, July 1, 2004; 232(1): 81 - 91.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
J. H. Ryu, J. L. Myers, and S. J. Swensen
Bronchiolar Disorders
Am. J. Respir. Crit. Care Med., December 1, 2003; 168(11): 1277 - 1292.
[Abstract] [Full Text] [PDF]

Home page
 ImagingHome page
L J King and S P G Padley
Imaging of the thorax in AIDS
Imaging, February 1, 2002; 14(1): 60 - 76.
[Abstract] [Full Text] [PDF]

Home page
 ThoraxHome page
W D Travis and J R Galvin
Rare diseases bullet 13: Non-neoplastic pulmonary lymphoid lesions
Thorax, December 1, 2001; 56(12): 964 - 971.
[Full Text] [PDF]

Home page
 Eur Respir JHome page
D.M. Hansell
Small airways diseases: detection and insights with computed tomography
Eur. Respir. J., June 1, 2001; 17(6): 1294 - 1313.
[Abstract] [Full Text] [PDF]

Home page
 RadioGraphicsHome page
J. P. Mayberry, S. L. Primack, and N. L. Muller
Thoracic Manifestations of Systemic Autoimmune Diseases: Radiographic and High-Resolution CT Findings
RadioGraphics, November 1, 2000; 20(6): 1623 - 1635.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Howling, S. J.
Right arrow Articles by Müller, N. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Howling, S. J.
Right arrow Articles by Müller, N. L.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
RADIOLOGY RADIOGRAPHICS RSNA JOURNALS ONLINE