Do Not Miss Acute Diffuse Panbronchiolitis for Tree-in-Bud: Case Series of a Rare Lung Disease

Area of Science:

• Pulmonology
• Radiology
• Toxicology

Background:

• Acute bronchiolitis typically affects infants, but can rarely manifest in adolescents and adults.
• Inhalation injuries from various substances can cause severe lung disease.
• Differentiating lung injuries is critical for appropriate patient management.

Purpose of the Study:

• To describe a rare clinical and imaging phenotype of acute diffuse panbronchiolitis in adolescents.
• To highlight the importance of distinguishing this condition from e-cigarette or vaping product-use-associated lung injury (EVALI).
• To emphasize the role of CT imaging and early diagnostics in identifying inhaled hazards.

Main Methods:

• Case series presentation of four unrelated adolescent patients.
• Detailed clinical assessment and high-resolution computed tomography (CT) imaging.
• Discussion of differential diagnosis, particularly EVALI.

Main Results:

• Four adolescent patients presented with severe bronchiolitis and a unique CT finding of an extensive tree-in-bud pattern.
• This pattern suggests a rare clinical phenotype of acute diffuse panbronchiolitis.
• The identified cases were linked to inhalation injury from waterpipes, smoked tobacco, and cannabinoids.

Conclusions:

• A distinct pattern of acute diffuse panbronchiolitis in adolescents is associated with specific inhalation exposures.
• CT imaging is vital for diagnosing this condition and differentiating it from EVALI.
• Early diagnostic procedures and sample preservation are recommended for identifying inhaled toxins.