Asthma and Associated Conditions: High-Resolution CT and Pathologic Findings
C. Isabela S. Silva1,
Thomas V. Colby2 and
Nestor L. Müller1,3
1 Department of Radiology, Vancouver General Hospital, 899 W 12th Ave.,
Vancouver, BC V5Z 1M9, Canada.
2 Department of Pathology, Mayo Clinic, 13400 E Shea Blvd., Scottsdale, AZ
85259.
3 Department of Radiology, University of British Columbia, 3350-950 W 10th Ave.,
Vancouver, BC V5Z 4E3, Canada.
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Fig. 1. —Photomicrograph of autopsy specimen obtained in 10-year-old boy with
fatal asthmaticus reveals bronchus with luminal mucus plug
(asterisks), thinning of surface mucosa (arrowheads), and
submembranous fibrosis (so-called basement membrane thickening) (vertical
straight arrows), muscle hypertrophy (horizontal straight
arrow), and inflammatory infiltrate (curved arrows) that is rich
in eosinophils. (H and E, low magnification)
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Fig. 2. —High-resolution CT scan obtained in 72-year-old woman with chronic
asthma shows bronchial wall thickening (large arrows) with associated
narrowing of bronchial lumen. Also noted are subtle areas of decreased
attenuation and vascularity (small arrows), which are more clearly
seen in Figures 3A and
3B.
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Fig. 3A. —52-year-old man with asthma and bronchiectasis. High-resolution MDCT
scan shows bilateral bronchiectasis (straight arrows) and areas of
decreased attenuation and vascularity (curved arrows). Note that
bronchi are dilated but are not thick-walled.
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Fig. 3B. —52-year-old man with asthma and bronchiectasis. Coronal reformatted
image shows ectatic bronchi and areas of decreased attenuation and vascularity
in lower lobes (arrows) and normal upper lobes.
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Fig. 4A. —Bronchiolar abnormalities in two patients with asthma.
Photomicrograph of histopathologic specimen obtained in 10-year-old boy with
fatal asthmaticus shows small bronchiole (outside diameter, 0.5 mm from
adventitia to adventitia) with muscle hypertrophy (short straight
arrow), submucosal and submembranous fibrosis (long straight
arrows), and inflammatory infiltrate (curved arrows) rich in
eosinophils. Goblet cell metaplasia (more typically seen in bronchi of
patients with asthma) is prominent and seen as pale swollen cells
(arrowheads) replacing much of columnar ciliated epithelium. Extent
of submembranous and submucosal fibrosis (structural remodeling) is indicative
of presence of mild constrictive bronchiolitis histologically. (H and E,
intermediate magnification)
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Fig. 4B. —Bronchiolar abnormalities in two patients with asthma.
Photomicrograph of histopathologic specimen obtained in 48-year-old woman with
long history of asthma shows bronchiole with submucosal thickening that was
caused by fibrous tissue (arrows) and resulted in luminal narrowing.
These findings are characteristic of mild constrictive bronchiolitis.
(Trichrome stain, intermediate magnification)
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Fig. 5A. —45-year-old woman with asthma and air trapping. High-resolution CT
scan obtained at level of aortic arch shows subtle areas (arrows) of
decreased attenuation and vascularity.
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Fig. 5B. —45-year-old woman with asthma and air trapping. High-resolution CT
scan obtained at maximal expiration shows bilateral areas of air trapping with
associated decrease (arrows) in vascularity. Presence of parenchymal
abnormalities due to airway obstruction is much more readily seen on
expiratory scan. Note invagination of posterior tracheal wall, which aids in
identifying this as expiratory scan.
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Fig. 6A. —27-year-old woman with asthma and cystic changes. Patient had never
smoked. Photomicrograph of histopathologic specimen shows strand of residual
alveolar tissue (curved arrow) remaining in cyst arising adjacent to
bronchiole (straight arrow). (H and E, low magnification)
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Fig. 6B. —27-year-old woman with asthma and cystic changes. Patient had never
smoked. CT scan (5-mm collimation) shows bilateral small localized rounded
areas of low attenuation (arrows) with well-defined smooth walls
consistent with cysts, raising concerns of possible lymphangioleiomyomatosis.
However, no evidence of lymphangioleiomyomatosis was found at surgical
biopsy.
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Fig. 7A. —Histopathologic specimens of allergic bronchopulmonary aspergillosis
(ABPA) obtained in 33-year-old woman with history of asthma. Diagnosis of ABPA
was based on findings of this biopsy. Photomicrograph shows sections of mucus
plug with typical features of allergic mucin with layering of mucus and cell
debris (arrows). (H and E, intermediate magnification)
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Fig. 7B. —Histopathologic specimens of allergic bronchopulmonary aspergillosis
(ABPA) obtained in 33-year-old woman with history of asthma. Diagnosis of ABPA
was based on findings of this biopsy. Photomicrograph obtained with higher
magnification than A shows that cell debris consists of degenerated
eosinophils with associated Charcot-Leyden crystals (arrows). (H and
E, high magnification)
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Fig. 8A. —73-year-old woman with allergic bronchopulmonary aspergillosis.
High-resolution CT scan of left upper lobe shows branching opacities
characteristic of mucoid impaction.
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Fig. 8B. —73-year-old woman with allergic bronchopulmonary aspergillosis.
High-resolution CT scan obtained at slightly higher level than A shows
that mucoid impaction is present in several small bronchi.
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Fig. 9A. —32-year-old woman with allergic bronchopulmonary aspergillosis.
High-resolution MDCT scan obtained shows central varicose bronchiectasis
(arrows) in both upper lobes.
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Fig. 9B. —32-year-old woman with allergic bronchopulmonary aspergillosis.
Coronal reformatted image shows varicose bronchiectasis (arrows) in
upper lobe and normal bronchi in lower lobe.
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Fig. 10A. —56-year-old man with allergic bronchopulmonary aspergillosis.
High-resolution MDCT scan obtained through upper lobes shows severe bilateral
bronchiectasis and marked bronchial wall thickening. Also noted is mucoid
impaction (arrows).
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Fig. 10B. —56-year-old man with allergic bronchopulmonary aspergillosis.
High-resolution MDCT scan obtained at level of lower lobe bronchi shows
central bronchiectasis, areas of decreased attenuation and vascularity, and
mucoid impaction (arrows).
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Fig. 10C. —56-year-old man with allergic bronchopulmonary aspergillosis.
Sagittal reformatted image of right lung shows equal severity of upper and
lower lobe bronchiectasis and extensive areas of decrease attenuation and
vascularity. Also noted are a few small centrilobular nodules
(arrows).
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Fig. 11. —Histopathologic specimen obtained in 50-year-old man shows foci of
eosinophilic pneumonia with air-space fibrin (straight arrows) and
numerous eosinophils (curved arrow) in air spaces. Also noted are
increased alveolar macrophages and mild mononuclear cell infiltrate. (H and E,
intermediate magnification)
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Fig. 12A. —75-year-old woman with chronic eosinophilic pneumonia.
High-resolution CT scan obtained at level of main bronchi shows extensive
consolidation in right upper lobe and small localized areas of ground-glass
attenuation and consolidation in left upper lobe.
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Fig. 12B. —75-year-old woman with chronic eosinophilic pneumonia.
High-resolution CT scan obtained at level of lower lung zones shows
consolidation exclusively in peripheral lung regions.
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Fig. 13A. —Histopathologic findings of Churg-Strauss syndrome in two patients.
Photomicrograph of pathologic specimen obtained in 67-year-old woman shows
vasculitis (arrow) involving small vessel at its branch point.
Transmural inflammatory infiltrate was mixed in composition, with histiocytes,
lymphocytes, and numerous eosinophils that are just barely discernible. (H and
E, intermediate magnification)
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Fig. 13B. —Histopathologic findings of Churg-Strauss syndrome in two patients.
Photomicrograph of pathologic specimen obtained in 50-year-old man shows areas
of consolidation and early necrosis (arrows) that primarily
represented degenerating eosinophils. Inflammatory interstitial and air-space
infiltrate is mixed in composition, and resulting consolidation obscures
underlying architecture of lung. (H and E, intermediate magnification)
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Fig. 14. —52-year-old man with Churg-Strauss syndrome. High-resolution CT scan
obtained at level of aortic arch shows bilateral focal areas of peripheral
consolidation. Appearance is identical to that of chronic eosinophilic
pneumonia or bronchiolitis obliterans with organizing pneumonia.
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Fig. 15A. —68-year-old woman with Churg-Strauss syndrome. High-resolution MDCT
scan obtained at level of upper lobes shows extensive bilateral septal
thickening. Also noted are bronchial wall thickening (arrows), small
peripheral ground-glass opacities, and a small right pleural effusion.
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Fig. 15B. —68-year-old woman with Churg-Strauss syndrome. Sagittal reformatted
image of right lung shows septal thickening predominately in upper lobe
(white arrows) and in dorsal regions of lower lobe. Also noted is
extensive bronchial wall thickening (black arrows).
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Copyright © 2004 by the American Roentgen Ray Society.
