Bronchiolitis
Start clinical pathway SCHN
Australiasian guideline: https://doi.org/10.1111/jpc.14104
Most common virus RSV
Others
HMNV
Pathophysiology:
Hx
URTI
Apnoeas (more common in prep)
DDx
See Wheeze
Bronchiolitis obliterans
CXR can be normal, or hyperlucent with patchy infiltrates. Occasionally, Swyer-James syndrome (unilateral hyperlucent lung)
PFT: obstruction
VP scan: moth-eaten appearance of multiple matched defects
CT: patchy areas of hyperlucency and bronchiectasis.
Dx: lung biopsy
Rx no definitive Rx
Multiple immunomodulators trialled
Australiasian guideline: https://doi.org/10.1111/jpc.14104
Most common virus RSV
Others
HMNV
Pathophysiology:
Hx
URTI
Apnoeas (more common in prep)
DDx
See Wheeze
Bronchiolitis obliterans
- LRTI insult > fibrosis
- adenovirus (3,7,21), mycoplasma, measles, legionella, influenza, and pertussis, parainfluenza, RSV, VZV)
- Hypersensitivity (avian antigens, mold)
- JIA, SLE, Scleroderma, Sjögrens
- SJS
- Toxic inhalation: NO2, NH3
- BOSyndrome: deterioration of lung graft in transplant
- GVHD
- Aspiration (GORD, ForBody)
- Drugs: penicillamine (Copper Chelator) cocaine
- Lumen obstruction > trapping / atelectasis
- Bronchiolitis obliterans organizing pneumonia (BOOP)
- extension of inflammation into alveolar
- Cough, fever, cyanosis, dyspnea, chest pain, and respiratory distress followed by initial improvement (easily confused with pneumonia, bronchitis, or bronchiolitis)
- Progression with increasing dyspnea, chronic cough, sputum production, and wheezing, hypoxemia, and crackles
CXR can be normal, or hyperlucent with patchy infiltrates. Occasionally, Swyer-James syndrome (unilateral hyperlucent lung)
PFT: obstruction
VP scan: moth-eaten appearance of multiple matched defects
CT: patchy areas of hyperlucency and bronchiectasis.
Dx: lung biopsy
Rx no definitive Rx
Multiple immunomodulators trialled