Clinical Features Of Respiratory Bronchiolitis-Associated Interstitial Lung Disease And Literature Review(A Case Report)

Objective: To analyse the clinical features and imaging characteristic of respiratory bronchiolitis-associated interstitial lung disease and therefore improve the recognition of the disease.Methods: This paper would retrospectively analyze the clinical materials of one patient with respiratory bronchiolitis-associated interstitial lung disease, which was proven histopathologically in the First Affiliated Hospital of Guangxi Medical University.Then the clinical manifestations, imaging data, pulmonary function tests and pathology will be analyzed combining with the discussion of domestic and international literatures.Results:(1)Clinical manifestations: The patient was a 59-yearold man,whose main symptoms were nonproductive cough repeatedly,chest discomfort and bibasilar end-inspiratory Velcro; Imaging findings: HRCT revealed diffuse ground glass opacity in the entire lungs, paraseptal emphysema and pulmonary bullae in the upper lungs.Other equipment inspection: Pulmonary function tests showed a mild obstructive abnormality, the diffusion capacity was normoal. Bronchoalveolar lavage contained large amounts of brown-pigmented macrophages. Pathology: Pathology showed the accumulation of brownish pigmented macrophages within respiratory bronchioles, with the infiltrate extending into neighboring alveoli. A chronic inflammatory cell infiltrate in bronchiolar and surrounding alveolar walls occurs. Thickening of the peribronchial alveolar septal by fibroblasts and collagen deposition is present. Prussian blue staining was positive.(2) There were total 67 patients had been reported from 1984 to January, 2015, including the male 36 cases,female 28 cases, the proportion was 1.29:1, 3 case reports didn’t tell us gender. A total of 63 patients about whether the presence of smoking or not was in statistics, in which there were 62 patients who smoked, while there were 1 patients who didn’t smoke. The average age of onset was 42.00 years. The most common clinical manifestations were dyspnea, nonproductive cough and pulmonary Velcro. On HRCT central and peripheral bronchial wall thickening, centrilobular nodules, reticular pattern and ground-glass opacities associated with upper lobe centrilobular emphysema are most frequently reported. Pulmonary function usually presents a mild to moderate reduction in DLco, while no specific changes in pulmonary ventilation function. Pathology showed typical respiratory bronchiolitis. There were 33 cases were included, among which there were 27 cases of validness, about 81.82%. The most common treatment methods include smoking cessation and smoking cessation with prednisone, in which there were 13 patients received simple smoking cessation, about 76.92% were effective. 15 patients received corticosteroid therapy along with smoking cessation, 93.33% of them were effective. A small number of patients received corticosteroid therapy alone. No statistical difference was found between the curative effect of three treatment groups.Conclusions:1. For the majority of patients with RB-ILD, the onset of symptoms usually occurr in the middle-aged crowd. RB-ILD is insidious and closely related to smoking. The main symptoms are different degrees of dyspnea, nonproductive cough and bibasilar endinspiratory Velcro. 2. The most common manifestations on HRCT are central and peripheral bronchial wall thickening, centrilobular nodules, reticular pattern and ground-glass opacities associated with upper lobe centrilobular emphysema. Pathology showed typical respiratory bronchiolitis: the accumulation of brownish pigmented macrophages within respiratory bronchioles, with the infiltrate extending into neighboring alveoli. A chronic inflammatory cell infiltrate in bronchiolar and surrounding alveolar walls occurs. 3. Currently quitting smoking is the main treatment. Most patients appear to stabilize or improve with smoking cessation. Some patients received corticosteroid therapy along, Some of them get certain curative effect. Whether or not smoking cessation and treatment with corticosteroids alter the natural history of RB-ILD remains unclear.