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Bronchiolitis obliterans in children: clinical profile and diagnosis
P W Chan1, R Muridan, J A Debruyne
1Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia. patrick@medicine.med.um.edu.my
Insights
Bronchiolitis obliterans (BO) in children often presents with persistent cough and wheeze. Viral infections are the most common cause, and diagnosis relies on clinical signs and imaging like chest X-rays and HRCT.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Radiology
Background:
- Bronchiolitis obliterans (BO) is a significant post-infectious pulmonary sequela in children.
- Understanding its clinical presentation, causes, and imaging characteristics is crucial for timely diagnosis and management.
Purpose of the Study:
- To elucidate the clinical profile, etiological factors, and radiological classifications of bronchiolitis obliterans in pediatric patients.
Main Methods:
- A retrospective review of medical records and radiological studies was conducted for 14 children diagnosed with BO.
- Analysis included clinical presentations, identified etiologies, and categorization of chest X-ray findings.
Main Results:
- The most frequent presentation was unresolving cough and wheeze post-respiratory illness.
- Viral pneumonitis was the leading identified cause (6 cases), followed by Mycoplasma pneumoniae (3 cases).
- Chest X-ray patterns included hyperinflation, mixed patterns, unilateral hyperlucency, and unilateral collapse; HRCT revealed hyperaeration and mosaic ground glass patterns in bilateral cases, associated with failure to thrive and persistent symptoms.
Conclusions:
- Bronchiolitis obliterans diagnosis can be established using clinical features alongside characteristic chest X-ray and HRCT findings.
- Viral etiology is the predominant cause of BO in the studied pediatric population.
Objective:
The aim of the study was to determine the clinical profile, aetiology and radiological categories in children diagnosed with bronchiolitis obliterans (BO).
Methodology:
We undertook a review of the medical records and radiological studies of 14 children with BO.
Results:
Unresolving cough and wheeze after a short respiratory illness was the commonest presentation. A viral pneumonitis was identified as the initial respiratory event prior to the development of BO in six children and Mycoplasma pneumoniae was the cause in another three children. Chest X-ray findings could be divided into four distinct patterns that were hyperinflation (n=5), mixed pattern of atelectasis, hyperlucency and bronchial thickening (n=4), unilateral small hyperlucent lung (n=3) and unilateral collapse of one lung (n=2). High resolution computed tomogram (HRCT) chest showing areas of hyperaeration and mosaic ground glass patterns with bronchial thickening were commonly found in patients whose chest X-ray showed bilateral changes. Patients with bilateral lung changes were more likely to have failure to thrive and persistent respiratory symptoms on follow up.
Conclusion:
A diagnosis of BO can be made from typical clinical features combined with an understanding of the different chest X-ray categories and HRCT of the chest. A viral aetiology was the commonest cause for BO in our series.
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