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Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
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Occupational constrictive bronchiolitis with normal physical, functional and image findings.

Sandra Figueiredo1, António Morais, Adriana Magalhães

  • 1Internato Médico, Serviço de Pneumologia, Hospital de São João (EPE), Porto, Portugal.

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Constrictive bronchiolitis, a condition causing airway narrowing, is difficult to diagnose. This case highlights its presence despite normal physical, functional, and imaging results, emphasizing the need for high suspicion.

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Area of Science:

  • Pulmonary Medicine
  • Respiratory System Pathology
  • Diagnostic Challenges in Bronchiolar Disorders

Background:

  • Constrictive bronchiolitis involves airway wall alterations leading to lumen narrowing or obliteration.
  • Clinical, functional, and radiologic findings can suggest bronchiolar disorders.
  • Diagnosis is challenging as constrictive bronchiolitis can occur with normal physical, functional, and imaging findings.

Purpose of the Study:

  • To report a case of constrictive bronchiolitis.
  • To illustrate the diagnostic difficulties associated with this condition.
  • To emphasize the importance of a high index of suspicion for invasive testing.

Main Methods:

  • Case report of a patient presenting with cough and dyspnoea.
  • Evaluation included physical examination, functional tests, and imaging studies.
  • Diagnosis was confirmed via pulmonary biopsy following invasive testing.

Main Results:

  • The patient exhibited normal physical, functional, and image findings.
  • Despite normal initial findings, the diagnostic work-up ultimately identified constrictive bronchiolitis.
  • Pulmonary biopsy confirmed the presence of constrictive bronchiolitis.

Conclusions:

  • Constrictive bronchiolitis can be present even with unremarkable physical, functional, and imaging assessments.
  • A high index of suspicion is crucial for diagnosing constrictive bronchiolitis.
  • Invasive diagnostic procedures, such as pulmonary biopsy, may be necessary when initial findings are normal.