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.


TERMINOLOGY


Abbreviations and Synonyms



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


Definitions



  • 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)


IMAGING FINDINGS


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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