Bronchocentric Granulomatosis

Bronchocentric Granulomatosis

Jud W. Gurney, MD, FACR

Axial HRCT shows nodular consolidation clustered along the airways image. A larger area of consolidation has a spiculated margin image.

Macroscopic pathology slide shows dilated bronchus image surrounded by inflammatory tissue image. The bronchus is also obliterated by inflammatory tissue image.


Abbreviations and Synonyms

  • Bronchocentric granulomatosis (BCG), allergic bronchopulmonary aspergillosis (ABPA)


  • Pathologic reaction characterized by bronchocentric necrotizing granulomatous process in which airway wall is replaced by granulomatous tissue and palisaded histiocytes

    • Airway lumen usually filled with necrotic debris

    • Multiple causes, divided into infectious and noninfectious (usually allergic)


General Features

  • Best diagnostic clue: Focal air-space mass or peripheral bronchiectasis and mucoid impaction

  • Patient position/location: Slightly favors upper lobes

  • Size: Air-space mass usually several cm in size

  • Morphology: Mass usually has spiculated margin

CT Findings

  • Nonspecific, 3 patterns

    • Radiographic patterns same no matter which clinical presentation

  • Air-space findings

    • Nodule or mass characteristics

      • Spiculated margin, 2-6 cm in size

      • Location: Upper lobes or superior segments of lower lobes

      • CT more sensitive for cavitation (air or fluid)

      • Contain air-bronchograms signifying air-space process

    • Consolidation

      • Lobar with mild volume loss

      • Mucoid impaction

      • May have multilobar disease (contralateral upper lobe)

      • Central airways patent (if central obstruction, consider bronchogenic carcinoma, which may have a pathologic pattern of BCG in the postobstructive lung)

  • Airways findings

    • Peripheral bronchiectasis or mucoid impaction

    • Central airways normal

  • Other

    • Mediastinal lymph node enlargement (< 10 mm short axis diameter) common

    • Pleural effusions uncommon

Radiographic Findings

Sep 20, 2016 | Posted by in RESPIRATORY IMAGING | Comments Off on Bronchocentric Granulomatosis

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