Traction bronchiectasis

In a 58-year-old woman who took nitrofurantoin 100 mg/day for 11 months, pulmonary toxicity occurred, with bilateral interstitial infiltrates in the lower zones of the chest X-ray and loss of lung volume (31). High resolution CT scans showed ground-glass opacification in the mid-thoracic region, with patchy fibrosis and traction bronchiectasis. After withdrawal of nitrofurantoin and administration of prednisone, a chest X-ray 3 months later showed resolution of the pulmonary changes. 

Fig. 26.4a,b. Axial CT image in a 63-year-old man with usual interstitial pneumonia (UIP)/idiopathic pulmonary fibrosis (IPF) shows bilateral reticular opacities, honeycombing (black arrowheads), and traction bronchiectasis (arrow). In addition, patchy, ground-glass opacities are present (white arrowhead) (a). Acute exacerbation in the same patient shows marked progression of ground-glass opacities (arrowheads) (b)... 

Fig. 26.12a,b. continued) Acute interstitial pneumonia (AIP) in a 58-year-old patient, b Fibrotic changes with traction bronchiectasis (arrow) and architectural distortion in the late phase of acute interstitial pneumonia (AIP)... 

When sarcoidosis progresses to fibrosis, architectural distortion and traction bronchiectasis classically radiating from the hilum to the adjacent upper and lower lobes can be found. Other common CT abnor-mahties in fibrotic sarcoidosis include honeycombing, cysts, and buUa formation. Airway stenosis in sarcoidosis is usually due to extrinsic scarring, or to endobronchial granulomas, whereas lymphadenopathy alone is a rare cause of symptomatic airway narrowing. 

Fig. 26.27. Axial CT image in a patient with progressive systemic sclerosis shows a mixture of fine reticular and ground-glass opacities (black arrows), associated with mild traction bronchiectasis (white arrow), consistent with a nonspecific interstitial pneumonia pattern. Note esophageal dilatation (arrowheads)...

Figure 2 HRCT of a patient with IPF demonstrating classic features including heterogeneous involvement with reticulation, architectural distortion, and honeycomb changes with a paucity of ground glass opacities. The black arrows indicate traction bronchiectasis. Abbreviations HRCT, high-resolution computed tomography IPF, idiopathic pulmonary fibrosis.

Figure 7 HRCT scan demonstrates cystic lesions, anatomic distortion, and traction bronchiectasis from advanced fibrocystic sarcoidosis. Abbreviation HRCT, high-resolntion thin-section CT.

Figure 9 HRCT scan demonstrates dense alveolar consolidation, multiple nodules, sarcoid galaxies, and traction bronchiectasis. Note the cavitary lesion with a mycetoma. Abbreviation-. HRCT, high-resolution thin-section CT.

HRCT features, reported in numerous studies (53,95,96,100-104), appear to be homogeneous, reflecting the high prevalence of a pure NSIP pattern (Fig. 2A,B) (100), compared with other CTDs. HRCT abnormalities include ground-glass attenuation (74—100%) and linear opacities (74—90%), alone or with traction bronchiectasis or bronchiolectasis (68-76%), consolidation (33%), and honeycombing (30-40%). Early disease is predominantly peripheral and posterior at... 

HRCT often discloses a complex admixture of lesions, termed rheumatoid lung. Bronchiectasis is present in 8% to 75% of patients, but the distinction between primary bronchiectasis and traction bronchiectasis due to pulmonary fibrosis is often difficult (139,140,149,151,152,155,166,177). Bronchiolitis is also frequent, manifesting as centrilobular nodules, tree-in-bud sign, mosaic perfusion, or air trapping (139,149,151,152,155,166,177). Emphysema is present in 5% to 43% of patients (13,139,140,149,151,152,155,166,174,177) and is widely viewed as a trait of RA-ILD, unlike findings in other CTDs. Emphysema is more frequent with an HRCT pattern of UIP, as opposed to NSIP (155). Other features include pulmonary rheumatoid nodules and pleural effusion or thickening can be observed. Pulmonary artery enlargement has been observed in nearly half of patients with RA-ILD, in spite of the fact that overt PH is rare in RA (155). 

In HRCT studies of PM/DM-ILD, ground-glass attenuation is the most frequent sign (48-100%), alone, or admixed with reticular opacities (50-83%). Other feamres include subpleural or peri-bronchovascular consolidation (40-100%), traction bronchiectasis or bronchiolectasis (14.8-67%), and honeycombing... 

Fig. 4.1. Mixed thin-section computed tomography patterns in an adult smoker. There is generalised ground-glass opacification in both lungs (taken to represent a component of respiratory bronchiolitis). In addition, there are signs of fibrosis a fine superimposed reticular pattern is seen, and there is evidence of traction bronchiectasis thin arrows) in the right lung. There is also centrilobular emphysema, of limited extent, in the right lung thick arrow)...

Fig. 12.2a,b. Aluminum pneumoconiosis, (a) Fine striations, nodular, and ground-glass opacities more pronounced in the upper and middle lung zones and displacement of the hila upwards are seen, (b) Thin-section computed tomography scan of the same patient shows areas of ground-glass attenuation around the bronchovascular bundles and traction bronchiectasis... 

Fig. 12.3a,b. A 52-year-old man with a history of exposure to aluminum for 7 years, (a) The chest radiograph reveals reticu-lonodular opacity, predominantly distributed in the lower lung zones, (b) Thin-section computed tomography scans show diffusely distributed reticular hyperattenuation. Traction bronchiectasis and honeycombing are present... 

Fig. 13.19. Chronic phase. Honeycombing with linear opacity. Note a traction bronchiectasis in the middle lobe...

Radiation fibrosis typically occurs 6 months or more after radiation therapy. Fibrotic changes are variably present between 30 and 40 Gy, and are always seen after 40 Gy. Permanent scarring resulting in respiratory compromise may develop if the dose and volume of lung irradiated are excessive. The HRCT findings consist of a reticular pattern with associated traction bronchiectasis limited to the radiation portal (Worthy et al. 1997 Wah et al. 2003) (Fig. 6.2.20). 

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