Panbronchiolitis%20-%20diffuse Diagnosis

• Bronchiectasis
• Bronchiolitis (infectious)
• Chronic bronchitis
• Cystic fibrosis
• Hypogammaglobulinemia
• Primary ciliary dyskinesia
• Allergic bronchopulmonary aspergillosis (ABPA)
• Obliterative bronchiolitis
• Sarcoidosis
• Mycobacterium Avium complex pulmonary infection
• Churg-Strauss syndrome
• Wegener’s granulomatosis

Diagnostic Criteria for DPB by Ministry of Health & Welfare of Japan

• Diagnosis of diffuse panbronchiolitis (DPB) is definite if the first 3 & at least 2 of the last 3 criteria are present
  
  • Presence of persistent cough, sputum production & dyspnea on exertion
  • History of chronic paranasal sinusitis
  • Chest X-ray (CXR) shows bilateral diffuse small nodular shadows, or chest computed tomography (CT) scan w/ centrilobular micronodules
  • Presence of coarse crackles, occasional rhonchi, wheezes or squawk on physical exam
  • FEV₁/FVC <70% & PaO₂ <80 mmHg
  • Cold haemmaglutinin titre ≥64

• Crackles, wheezing on chest exam

Pulmonary Functions Tests

• Spirometry, lung volume determination
  
  • May show significant obstructive defect w/ or w/o superimposed restriction
  • Significantly limited airways resistant to bronchodilators
  • FEV₁/FVC <70%, vital capacity (VC) <80%, residual volume (RV) >150%
  • Hypoxemia may be present in blood gas analysis
• P. aeruginosa infection, reduced pulmonary diffusing capacity, progression of hypoxemic state & subsequent hypercapnia seen in advanced stages of diffuse panbronchiolitis (DPB)

• Chest X-ray (CXR)
  
  • May show pulmonary hyperinflation & diffuse bilateral small nodular shadows
  • Findings of bronchiectasis (ring-shaped/tram-line shadows) may be seen in advanced disease

• High-resolution computerized tomography (HRCT)
  
  • Bilateral & symmetric centrilobular nodules forming a “tree-in-bud” pattern,
  • Bronchiolectasis
  • Mosaic air trapping on lung periphery