Two Case Reports of Diffuse Panbronchiolitis with Preceding Central Airway Diseases

Abstract

Two cases of diffuse panbronchiolitis (DPB) were presented. The first case, a 56-year-old man, had preceding middle lobe syndrome and chronic sinusitis. Chest roentgenogram did not show the nodular shadows of DPB, but computed tomography (CT) revealed small nodules around the peripheral pulmonary artery branches, showing centrilobular distribution. This case was histologically proven to be DPB by transbronchial lung biopsy. The second case, a 39-year-old woman, had been suffering from bronchiectasis of left lung and chronic sinusitis. Diffuse nodular shadows on chest roentgenogram were present from 5 years ago, though those findings could not be detected 10 years ago. The clinical criteria for DPB were satisfied. These cases might suggest the possibility that DPB had similar pathological mechanism (s) in terms of immunological background and/or defence mechanisms of the airway system, as bronchiectasis and middle lobe syndrome. CT is a very sensitive modality for detecting the small nodules of DPB, such that early stage of DPB, which is not revealed as nodular shadows on routine chest roentgenogram can be recognized.